Efficacy and durability of robotic heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up

Abstract

There is a dearth of long-term follow-up data to support the effectiveness of RHM. This study demonstrates durable dysphagia relief in the vast majority of patients with a high degree of patient satisfaction and a low rate of esophageal mucosal injury. While a significant proportion of patients report reflux symptoms, these symptoms are well controlled with medical acid suppression.

Long Term Outcomes of Surgical and Clinical Symptoms Following Minimally Invasive Heller Myotomy: A Retrospective Clinical Database Review

“…35 Perry et al, evaluated the difference in medication use between MIS approaches, and found 56% of robotic patients and 80% of laparoscopic patients required medication for reflux at LT follow-up. 14 While they cite their PPI use as "very high," the authors point to a need for objective testing to determine if the symptoms are truly a result of acid reflux. Others have reported more descriptive breakdowns, with 41%, 7% and 2% of patients post-operatively taking PPIs, CCBs, and Nitroglycerine, respectively.…”

“…12,13 Still, fewer authors have looked at robotic HM, with small cohorts ranging from 14-56 patients. 14,15 Therefore, despite the data that exist on MIS benefits for surgical procedures in general, there is a lack of research substantiating feasibility and LT results after both minimally invasive Heller approaches, especially those with a long follow-up time. Given the efficacy of minimally invasive approaches in other surgical fields, the aim of our study was to evaluate short and LT symptom improvement in patients who underwent MIHM.…”

Robotic Heller myotomy

“…In comparison, minimally invasive Heller myotomy is currently the gold standard surgical approach for achalasia as it has the best long-term outcome. Although per-oral endoscopic myotomy (POEM) and robotic Heller myotomy (RHM) are increasingly being used, laparoscopic Heller myotomy (LHM) is the longest practiced surgical approach with safe and effective outcomes [8,9,[12][13][14][15] .…”

“…It was first described in 2001 in a case report by Melvin et al [16] . At this point, outcomes are somewhat controversial for RHM compared to LHM; however, many studies report that it is equivalent to LHM in terms of achieving the desired result of symptomatic relief but with fewer complications related to mucosal perforation [9,13,14,[17][18][19][20] . Cost remains one of the largest barriers to overcome in robotic operations; however, cost reduction strategies can be further explored with increased utilization [10,17,19,21] .…”

The choice of myotomy in achalasia cardia: Heller's or per-oral endoscopic myotomy

“…RAHM has equal efficacy to Laparoscopic Heller's myotomy (LMH) but lower rate of mucosal perforations. [1] Therefore, it is possible that more number of surgical myotomies may be robot assisted in the near future. However, RAHM is costlier in comparison to LHM.…”