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Achalasia Procedures //
Robotic Achalasia Surgery |
Robotic Heller Myotomy with some type of fundoplication has been shown to have the BEST LONG-TERM RESULTS. This technique typically involves making 5 tiny incisions (8mm) and performing the procedure typically in 1 to 1 1/2 hours. This procedure is performed as an outpatient procedure in most cases with patients either going home the same day or the next day. Patients usually are sent home without any reflux medications and advised to advance their diet.
The technique has been modified over the last 20 years and the length of the incision as well as the type of wrap play an important role in the outcome of the procedure.
What has been learnt has been that adequate myotomies are important for successful outcomes as far as relieving symptoms. However, failure of performing an anti-reflux procedure leaves patients prone to reflux in 60-80% of cases. With appropriate wrap placement, this rate drops to 5%. Otherwise, you are replacing one disease with another and will require long term medications to treat the reflux.
The more recent advance has been the use of robotics to perform the procedure that leads to a significant reduction in perforation and longer hospital stays.
Overall, most patients do very well. We do follow you closely for issues as this is a chronic disease and may require more interventions.
Our goal is to get you back to being yourself and improving your quality of life.
Per Oral Myotomy (Endoscopic) |
This procedure involves general anesthesia and you are intubated for the procedure similar to the robotic Heller and the procedure takes approximately 1 1/2 hours. You are typically in the hospital for 2 days and are sent home on a 3-month course of anti-reflux medications after which time we will assess if you have any evidence of reflux.
The recovery pattern is similar to the Heller myotomy and the diet is advanced as you can tolerate. The resolution of your difficulty swallowing which is the most common symptom with achalasia will usually resolve. Although long term data is still lacking.
Reflux is however a common issue with data ranging from 40-80%. This requires typically lifelong anti-reflux medications or further intervention surgically for resolution.
Although we believe this is an important tool in the management of achalasia and given the identical procedure risks patients will be candidates for both procedures but the outcomes and reflux rates of the robotic approach will typically surpass that of the endoscopic procedure due to the anti-reflux component of the operation.
We believe this is an excellent procedure to avoid reoperative Heller and will be used in our algorithm as third line therapy in complex cases.
Complications rates including perforation will typically be around 6%.
Endoscopic Balloon Dilation |
This procedure involves general anesthesia and you are intubated for the procedure similar to the robotic Heller and the POEM. However, this procedure is typically fast taking usually 30-45min. You typically go home the same day and are sent home on a 3-month course of anti-reflux medications after which time we will assess if you have any evidence of reflux.
The recovery pattern faster than the 2 other procedures and the diet is advanced as you see fit. The resolution of your difficulty swallowing which is the most common symptom with achalasia will usually resolve but typically this requires 3 rounds of dilation with increasing size balloons. Data comparing outcomes compared to Heller showed similar outcomes for improvement in difficulty swallowing.
Reflux is however a common issue with data ranging from 40-80%. This requires typically lifelong anti-reflux medications or further intervention surgically for resolution.
Although we believe this is an important tool in the management of achalasia given that it requires typically at least THREE Dilations for improvement over several months with repeat exposure to anesthesia and higher reflux rates when compared to the robotic approach we typically perform this procedure as second line therapy after patients have issues with the initial surgery.
We believe this is an excellent procedure to avoid reoperative Heller and will be used in our algorithm as second line therapy in cases when patients have return of symptoms.
Complications rates including perforation will typically be around 3-4%.
Recommended Algorithm for Best Results |
Procedure Comparison |
