Laparoscopic revisional surgery following failure of primary laparoscopic Heller's myotomy for achalasia cardia: A single-centre series.

INTRODUCTION

Redyspahgia following laparoscopic has been documented with many causative factors. Peroral endoscopic myotomy, botulinum injections and dilatations have been suggested; however, relaparoscopic Hellers has a role to play, not only to correct or extend the myotomy but allows take down of the improper fundal wrap if leading to dysphagia. We studied our series of 18 patients who had to be reoperated for lap hellers cardiomyotomy (LHCM).

PATIENTS AND

METHODS

The retrospective study was done over 15 years of patients presenting with dysphagia operated in the past for LHCM. A total of 18 patients were studied. Eckardt score following the primary surgery >3 were included and thoroughly investigated. The majority had dysphagia as complaints with primary surgery as LHCM.

RESULT: 12 out of 18 patients had incomplete initial myotomy, 10 had incomplete extension on cardia, with one requiring epiphrenic diverticulectomy. All other than one were subjected for ReHellers Cardiomyotomy, which was done at 9 o'clock. The mean Eckardt scores were significantly reduced from the values of 6.38 ± 0.74 preoperatively to 2.0 ± 1.67 postoperatively (P < 0.01). Symptomatic improvement was seen in 88.8% patients with one patient had Eckardt score >6 and denoted as treatment failure. None had any symptoms of reflux.

CONCLUSION

Laparoscopic redo surgery, although challenging provides excellent outcomes, using standardised steps in experienced hands, along with permitting to tackle multiple contributory causes of dysphagia and hence is safe, feasible and effective treatment option following the failure of index surgical myotomy in surgically fit patients.