Outcomes of laparoscopic Heller myotomy without fundoplication on gastroesophageal reflux disease and dysphagia in type II Achalasia: A prospective study
Researcher Bulletin of Medical Sciences,
Vol. 30 No. 1 (2025),
20 June 2026
,
Page e9
Abstract
Objective: Achalasia is an uncommon esophageal motility disorder that significantly impacts quality of life due to dysphagia, chest pain, and other related symptoms. Laparoscopic Heller myotomy (LHM) is a preferred treatment, although the necessity of adding fundoplication to prevent postoperative gastroesophageal reflux disease (GERD) remains debated.
Materials and Methods: This prospective cohort study from January 2023 to March 2024 at Imam Hossein Teaching and Therapeutic Center included 25 patients with type II achalasia. The study assessed the incidence and severity of GERD and dysphagia postoperatively at baseline, 3 months, and 6 months using the Achalasia Patient-Reported Outcomes Questionnaire (APRO), Brief Esophageal Dysphagia Questionnaire (BEDQ), and Gastro-Esophageal Reflux Disease Questionnaire (GERDQ).
Results: Post-surgery, dysphagia scores decreased significantly from 18.96 (SD = 4.02) to 12.11 (SD = 3.88) at 3 months (p < 0.01) and to 11.45 (SD = 3.67) at 6 months (p = 0.64). GERD scores also significantly reduced from 19.32 (SD = 4.18) to 9.14 (SD = 3.77) at 3 months (p < 0.05) and to 4.97 (SD = 2.45) at 6 months (p = 0.001).
Conclusion: LHM without fundoplication significantly reduces dysphagia in type II achalasia. Although effective in alleviating this primary symptom, it does not consistently prevent postoperative GERD, highlighting the need for individualized surgical planning.
- Achalasia; Laparoscopic Heller myotomy; Gastroesophageal reflux disease; Dysphagia; Fundoplication
How to Cite
References
. Gockel I, Sgourakis G, Drescher DG, Lang H. Impact of minimally invasive surgery in the spectrum of current achalasia treatment options. Scand J Surg. 2011;100(2):72-77.
2. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526-33.
3. Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg. 2009;208(1):151-162.
4. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807-1816.
5. Yaghoobi M, Mayrand S, Martel M, et al. Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc. 2013;78(3):468-475.
6. Patti MG, Pellegrini CA. Esophageal achalasia: pneumatic dilatation or laparoscopic myotomy? J Gastrointest Surg. 2012;16(4):870-873.
7. Stefanidis D, Richardson W, Farrell TM, et al. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc. 2012;26(2):296-311.
8. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238-1249; quiz 1250.
9. Yalav O, Topal U, Yavuz B, et al. Surgical myotomy and anterior fundoplication for achalasia disease: Short-term outcomes. Ann Ital Chir. 2021; 92:149-154.
10. Rebecchi F, Allaix ME, Schlottmann F, et al. Laparoscopic Heller Myotomy and Fundoplication: What Is the Evidence? Am Surg. 2018;84(4):481-488.
11. Torres-Villalobos G, Martin-Del-Campo LA. Surgical treatment for achalasia of the esophagus: laparoscopic Heller myotomy. Gastroenterol Res Pract. 2013; 2013:708327.
12. Elyasinia F, Sadeghian E, Gapeleh R, et al. The role of fundoplication after laparoscopic Heller myotomy in reducing postoperative symptoms in patients with achalasia: A controlled clinical trial. Middle East J Dig Dis. 2022;14(4):437-442.
13. Pandolfino JE, Carlson DA, McGarva J, et al. Validation of the Achalasia Patient-Reported Outcomes Questionnaire. Aliment Pharmacol Ther. 2022;56(10):1434-1443.
14. Taft TH, Riehl M, Sodikoff JB, et al. Development and validation of the brief esophageal dysphagia questionnaire. Neurogastroenterol Motil. 2016;28(12):1854-1860.
15. Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(1):52-57.
16. Santoro G, Sheriff N, Noronha J, et al. Heller myotomy versus Heller myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis. Ann R Coll Surg Engl. 2022;104(3):154-164.
17. Kummerow Broman K, Phillips SE, Faqih A, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: long-term symptomatic follow-up of a prospective randomized controlled trial. Surg Endosc. 2018;32(4):1668-1674.
18. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240(3):405-412; discussion 412-415.
19. Rebecchi F, Giaccone C, Farinella E, et al. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg. 2008;248(6):1023-1030.
20. Torres-Villalobos G, Martin-Del-Campo LA. Surgical treatment for achalasia of the esophagus: laparoscopic Heller myotomy. Gastroenterol Res Pract. 2013; 2013:708327.
21. Finley CJ, Kondra J, Clifton J, et al. Factors associated with postoperative symptoms after laparoscopic Heller myotomy. Ann Thorac Surg. 2010;89(2):392-396.
22. Rawlings A, Soper NJ, Oelschlager B, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26(1):18-26.
23. Rossetti G, Brusciano L, Amato G, et al. A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long-term follow up. Ann Surg. 2005;241(4):614-621.
- Abstract Viewed: 4 times