Results of laparoscopic Heller-Toupet operation for achalasia

J. M. Perrone, M. M. Frisella, K. M. Desai, N. J. Soper

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background: Laparoscopic myotomy has become the preferred treatment for achalasia. Controversy persists on the need for fundoplication and/or its type; when used, most series have utilized the Dor fundoplication. We report a large series of laparoscopic Heller-Toupet procedures. Methods: All patients operated for achalasia were entered into a prospective database. Pre and postoperative esophageal symptoms, satisfaction scores, and SF-36 variables were compared. Surgical failures were defined as recurrent or persistent dysphagia leading to secondary treatment. Data are expressed as mean ± S.D. Results: One hundred consecutive cases were analyzed (61 men, 39 women, age 47 ± 17 yr). Heller-Toupet was performed in 94, whereas six patients had a Dor fundoplication because of mucosal perforation (three) or technical difficulties performing a posterior wrap (three). Operative time was 148 ± 21 min. There were 13 intraoperative adverse events managed laparoscopically, and no conversions. Minor postoperative complications were noted in two cases, whereas there were no major complications or deaths. Mean hospital stay was 1.2 ± 0.5 days, (range 1-4). Follow-up was complete in 92% at 26 ± 17 months. Failures leading to further treatment occurred in 4%. All symptom scores were significantly improved (p < 0.0001). Solid dysphagia score went from 6.4 to 1.0 postoperatively; regurgitation score went from 4.5 to 0.2 (combined frequency and severity, range 0-8). Postoperative global esophageal symptoms scale revealed improvement in 97%, and all domains of the SF-36 were improved. Conclusions: Although the best surgical approach to achalasia is yet to be determined, laparoscopic Heller-Toupet operation in experienced hands is a safe and effective procedure with low rates of morbidity and failure and high patient satisfaction.

Original languageEnglish (US)
Pages (from-to)1565-1571
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Issue number11
StatePublished - Nov 2004
Externally publishedYes


  • Achalasia
  • Heller-Toupet operation
  • Laparoscopy

ASJC Scopus subject areas

  • Surgery


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