Reasons and Prevalence of Reoperations After Esophagomyotomy for Achalasia

Background: Surgical esophagomyotomy has been shown to provide superior long-term symptom relief as compared with nonsurgical interventions. Failure of surgical treatment remains the center of controversy regarding this topic. Methods: A retrospective review was conducted of all patients who underwent surgical treatment of achalasia from January 2005 to July 2009 at Cleveland Clinic Florida. Results: A total of 66 patients (41 women and 25 men), with a mean age of 51 years (range, 24 to 86y). Fifty-nine patients (89%) underwent laparoscopic surgery, including 2 (3%) with recurrent achalasia. One patient was converted to laparotomy. Twelve patients required a reintervention because of failure or complications (18%). Six cases were confirmed intraoperatively to be recurrent achalasia that necessitated redo Heller myotomy. Conclusions: Early reoperations after Heller's Dor esophagomyotomy are mostly related to technical errors, whereas most late reoperations are related to recurrent disease. Laparoscopy seems to be safe and the preferred approach for primary as well as redo procedures.