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Patti et al. Mini-invasive Surg 2022;6:38 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.19

Opinion Open Access

Laparoscopic Heller myotomy and robotic Heller

myotomy: when is it indicated?

2
1
Marco G. Patti , Francisco Schlottmann , Fernando A. M. Herbella 3
1
Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA.
2
Department of Surgery, University of Illinois, Chicago, IL 60607, USA.
3
Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, SP, 04037-003, Brazil.
Correspondence to: Dr. Marco G. Patti, Department of Surgery, University of Virginia, 200 Jeanette Lancaster Way
Charlottesville, Charlottesville, VA 22903, USA. E-mail: Marco.patti@gmail.com
How to cite this article: Patti MG, Schlottmann F, Herbella FAM. Laparoscopic Heller myotomy and robotic Heller myotomy:
when is it indicated? Mini-invasive Surg 2022;6:38. https://dx.doi.org/10.20517/2574-1225.2022.19
Received: 17 Feb 2022 First Decision: 14 Mar 2022 Revised: 14 Mar 2022 Accepted: 22 Mar 2022 Published: 4 Jul 2022

Academic Editor: Farid Gharagozloo Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Achalasia is a primary motility disorder of unknown origin. Palliative treatment is often adopted to resolve its
symptoms by eliminating the resistance due to a non-relaxing and hypertensive lower esophageal sphincter. There
are three available effective treatment modalities: pneumatic dilation, laparoscopic Heller myotomy with
fundoplication, and peroral endoscopic myotomy. In choosing the proper treatment, it is important to remember
that the esophagus lacks peristalsis in patients with achalasia. So once the lower esophageal sphincter is
eliminated, reflux may occur with the potential of causing reflux symptoms, esophagitis, peptic strictures, Barrett’s
esophagus, and cancer. For this reason, we believe that laparoscopic myotomy offers the best chance in most
patients of improving esophageal emptying while protecting them from abnormal reflux.
Keywords: Achalasia, high-resolution manometry, Chicago Classification, pneumatic dilation, laparoscopic Heller
myotomy, peroral endoscopic myotomy, gastroesophageal reflux, robotic surgery

INTRODUCTION
Esophageal achalasia is a primary esophageal disorder of unknown origin characterized by a non-relaxing
and often hypertensive lower esophageal sphincter (LES) and lack of esophageal peristalsis. The goal of
treatment is to eliminate the resistance posed by the LES, allowing the passage of food from the esophagus
into the stomach by gravity.

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