Impact of esophageal myotomy length during laparoscopic Heller myotomy for achalasia type II

Authors

  • Cristopher Rosales-Vazquez Departament of Surgery, Universidad de Monterrey (UDEM), Monterrey, Nuevo León, México
  • Giova Camacho-Cervantes Departament of Surgery, Universidad de Monterrey (UDEM), Monterrey, Nuevo León, México
  • Carlos I. Verdugo-Salazar Departament of Surgery, Universidad de Monterrey (UDEM), Monterrey, Nuevo León, México
  • Samuel R. Gomez-Arenas Departament of Surgery, UMAE Hospital de Especialidades No. 25 IMSS, Monterrey, Nuevo León, México
  • Yamir A. Nacud-Bezies Departament of Surgery, UMAE Hospital de Especialidades No. 25 IMSS, Monterrey, Nuevo León, México

DOI:

https://doi.org/10.18203/2349-2902.isj20251452

Keywords:

Achalasia, Heller myotomy, Esophageal surgery, Myotomy length, Eckardt score, Esophageal motility disorder

Abstract

Background: Type II achalasia (Ach2) is the most prevalent esophageal motility disorder. Current guidelines recommend laparoscopic Heller myotomy (LHM) as a standard treatment, but the optimal esophageal myotomy length remains under investigation.

Methods: A retrospective cohort study was conducted from 2018 to 2023 at a tertiary care center. Consecutive Ach2 patients undergoing LHM were included. Patients were grouped based on myotomy length (short vs long). Outcomes assessed included operative time, adverse events, Eckardt scores at 6 and 12 months, and treatment success.

Results: Fifty-one patients were analyzed. Eckardt score at 6 months was significantly lower in the long myotomy group compared to the short group (1.2±1.1 vs 0.6±1.2, p=0.023). At 12 months, Eckardt scores were also significantly better in the long myotomy group (1.8±1.7 vs 0.9±1.2, p=0.033). Treatment success at 12 months was 92% in the short group and 100% in the long group, but it was not statistically significant (p=0.191).

Conclusions: LHM provides high clinical success in Ach2 patients. While treatment success at 12 months was similar between groups, longer myotomy was associated with significantly lower Eckardt scores at both 6 and 12 months. These findings suggest a potential benefit in symptom control with longer myotomy, supporting further prospective studies to determine its clinical utility.

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Published

2025-05-20

How to Cite

Rosales-Vazquez, C., Camacho-Cervantes, G., Verdugo-Salazar, C. I., Gomez-Arenas, S. R., & Nacud-Bezies, Y. A. (2025). Impact of esophageal myotomy length during laparoscopic Heller myotomy for achalasia type II. International Surgery Journal, 12(6), 900–903. https://doi.org/10.18203/2349-2902.isj20251452

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Original Research Articles