Redo laparoscopic surgery for achalasia

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Abstract
Operative treatment of achalasia can fail in 10% to 15% of patients. No information is available on the outcome of laparoscopic reoperation for achalasia. Data from patients undergoing redo surgery for achalasia were prospectively collected. The data were analyzed, and a questionnaire was sent to all the patients. Eight patients underwent redo procedures at our institution between 1994 and 1998. The reasons for failure of the initial operations were incomplete myotomy (n=5), incorrect diagnosis (n=2), and new onset of reflux symptoms (n=1). All the redo procedures were performed laparoscopically. All the patients except one had excellent or good results. The average symptom severity score for dysphagia, regurgitation, chest pain, cough, and heartburn all improved after redo procedures. The average quality of life score improved from poor to good. Laparoscopic reoperation for achalasia is safe and feasible. It results in symptom improvement for most patients. Surgeon experience and recognition of the cause for failure of the original operation are most important in predicting the outcome.