Roque GR, Martínez AMÁ, Pereira FJG, Villanueva RA, Jiménez RR, Anido EV

Language: Spanish
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ABSTRACT

Introduction: Heller's cardiomyotomy associated with the antireflux procedure described by Dor is the treatment of choice in patients with esophageal achalasia. However, the causes of treatment failure are still controversial.
Objective: To describe the causes of failure of Heller's myotomy in patients operated for esophageal achalasia and the clinical progress of patients who required another surgery.
Methods: A descriptive, retrospective and longitudinal study was performed in a series of patients who required another surgery due to failed Heller's myotomy at the National Center for Minimally Invasive Surgery from January 2010 to December 2016.
Results: Heller's myotomy was performed in 253 patients diagnosed with esophageal achalasia. Among these patients, 7 (2.7%) required another surgery due to the relapse of symptoms, 4 (1.5%) were initially operated at the institution, and the rest were referred from other institutions in the country. The average age was 41±15 years (range 20-59). The most frequent symptoms were postoperative dysphagia and weight loss (100%). The time of symptoms relapse after the first surgery was 6-12 months in 4 patients (57%), 12-18 months in 1 (16%) and 18-24 months in 2 (33 %) patients.
Conclusions: Incomplete myotomy was the main cause of reintervention, laparoscopic myotomy with or without fundoplication being the surgical technique of choice for these patients, who had an excellent or good postoperative clinical evolution.