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Ann Thorac Surg 2004;77:385-392
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique

Kenneth A. Kesler, MDa*, Stacey E. Tarvin, MSa, Jo Ann Brooks, DNSa, Karen M. Rieger, MDa, Glen A. Lehman, MDb, John W. Brown, MDa

a Department of Surgery, Thoracic Division, Indiana University School of Medicine, Indianapolis, Indiana, USA
b Department of Medicine, Gastroenterology Division, Indiana University School of Medicine, Indianapolis, Indiana, USA

* Address reprint requests to Dr Kesler, Indiana University School of Medicine, Department of Surgery, Thoracic Division, 545 Barnhill Dr, EH 215, Indianapolis, IN 46202, USA
e-mail: kkesler{at}iupui.edu

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31-Feb 2, 2003.

BACKGROUND: Several surgical methods have been described to treat achalasia with a recent trend toward utilizing minimally invasive techniques to perform a myotomy. Since 1998 our institution has utilized a minimally invasive thoracoscopy-assisted technique (ThAM) that allows a myotomy to be performed under direct visualization.

METHODS: From 1992 to 2002, 57 patients underwent transthoracic Heller myotomy at our institution. Thirty-eight patients (67%) who underwent ThAM were reviewed and compared with 19 (33%) who previously underwent myotomy through a standard open left thoracotomy (OM).

RESULTS: There were no operative deaths in the ThAM group (n = 38) and 4 patients (11%) experienced minor morbidity. Four ThAM patients required conversion to open thoracotomy and 2 were lost to follow-up. Of the remaining 32 patients, 29 have improved postoperative dysphagia scores after a mean follow-up of 17 months. Only 4 patients have required further endoscopic or surgical intervention. Compared with the OM group, ThAM patients experienced significantly shorter average surgery time (97 versus 139 minutes), less blood loss (80 versus 155 mL), less postoperative narcotic requirement (8 versus 20 days), and shorter recovery to normal activity (20 versus 73 days).

CONCLUSIONS: Thoracoscopy-assisted myotomy results in excellent relief of dysphagia in the short term and would be expected to have long-term results similar to OM. Shorter operating and recovery times as compared with OM without the need for an antireflux procedure makes ThAM an attractive minimally invasive technique.






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