The feasibility, safety and outcomes of laparoscopic re-operation for achalasia

David R C James, Sanjay Purkayastha, Omer Aziz, Iakovos Amygdalos, Ara W Darzi, George B Hanna, Emmanouil Zacharakis

Research output: Contribution to journalReview articlepeer-review


INTRODUCTION: Heller myotomy for achalasia is associated with a recurrence rate of around 10%, thus reoperative surgery is often necessitated. This paper aims to review the available literature on laparoscopic reoperation for achalasia in order to assess its feasibility and effectiveness.

MATERIAL & METHODS: A Medline, Embase, Ovid, Cochrane database and Google(TM) Scholar search was performed with the following Mesh terms: "laparoscopic", "redo", "reoperative", "Heller's", "esophagomyotomy" and "achalasia". Outcomes of interest included patient demographics and details of primary procedure, operative details, intra- and post operative complications and symptom scores.

RESULTS: Seven studies reported outcomes from 54 cases. Conversion occurred in 7% (4/54) of cases. Thirteen percent (7/54) of patients sustained intra-operative gastric or oesophageal perforation; however these were all noted and repaired intra-operatively leading to no subsequent morbidity. No deaths were reported. Pre- and post operative symptom scores were heterogeneous, however did appear to improve after the procedure.

DISCUSSION: This review demonstrates that laparoscopic reoperation for achalasia is feasible and safe with complication rates comparable to the primary laparoscopic operation. It is recommended that laparoscopic reoperative Heller's myotomy should only be performed by surgeons with special interest in oesophagogastric surgery and adequate experience in laparoscopic surgery for achalasia.

Original languageEnglish
Pages (from-to)161-167
Number of pages7
JournalMinimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
Issue number3
Publication statusPublished - May 2012


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Achalasia/drug therapy
  • Feasibility Studies
  • Female
  • Humans
  • Laparoscopy/adverse effects
  • Male
  • Middle Aged
  • Reoperation/adverse effects
  • Treatment Outcome
  • Young Adult

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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