Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy

Research output: Contribution to journalArticle

Aman B. Ali, Najah A. Khan, Duc T. Nguyen, Ray Chihara, Edward Y. Chan, Edward A. Graviss, Brian J. Dunkin, Min Peter Kim

Background: Achalasia is an uncommon disease treated by decreasing the lower esophageal sphincter resting pressure. This study compared the safety and efficacy of esophago-gastric myotomy via laparoscopic, robotic, and per-oral endoscopic approaches. Methods: A retrospective review of data on patients with achalasia or other esophageal dysmotility disorder undergoing laparoscopic, robotically assisted, or per-oral endoscopic myotomy (POEM) procedures between 2013 and 2017 was performed. Patient demographics, comorbidities, procedure details, length of stay, 30-day readmission rate, and combined technical complication (full-thickness injury, conversion to open, and delayed perforation) were compared. Multiple logistic regression analysis was performed to determine which factors contributed to combined technical complication. Results: There were 171 patients who underwent esophago-gastric myotomy with 161 (94.2%) having achalasia. There were 40 laparoscopic Heller myotomies with partial fundoplication, 44 robotic Heller myotomies with partial fundoplication, and 87 POEM procedures performed during the study period. Baseline statistical differences were found among the groups in regard to gastroesophageal reflux symptoms, arrhythmia, hypertension, and congestive heart failure. Laparoscopic Heller myotomy had significantly higher combined technical complications (7, 17.5%) compared to robotically assisted Heller myotomy (0, 0%) and POEM (1, 1.1%). Multivariate analysis showed that laparoscopic Heller myotomy (OR 32.22; 95% CI 2.66, 389.83; p = 0.01), myocardial infarction (OR 27.94; 95% CI 1.66, 471.10; p = 0.02), and history of smoking (OR 8.87; 95% CI 1.29, 61.15; p = 0.03) were risks for developing combined technical complications. Conclusion: Robotically assisted Heller myotomy and POEM are safe and efficacious treatments for achalasia with lower rates of technical complications compared to laparoscopic Heller myotomy. With the advancements in endoscopic instruments and robotic surgery, POEM and robotically assisted Heller myotomy should be considered in the treatment of achalasia and esophageal dysmotility disorders.

Original languageEnglish (US)
Pages (from-to)3191-3196
Number of pages6
JournalSurgical Endoscopy
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2020

PMID: 31482358

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Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. / Ali, Aman B.; Khan, Najah A.; Nguyen, Duc T.; Chihara, Ray; Chan, Edward Y.; Graviss, Edward A.; Dunkin, Brian J.; Kim, Min Peter.

In: Surgical Endoscopy, Vol. 34, No. 7, 01.07.2020, p. 3191-3196.

Research output: Contribution to journalArticle

Harvard

Ali, AB, Khan, NA, Nguyen, DT, Chihara, R, Chan, EY, Graviss, EA, Dunkin, BJ & Kim, MP 2020, 'Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy' Surgical Endoscopy, vol. 34, no. 7, pp. 3191-3196. https://doi.org/10.1007/s00464-019-07093-2

APA

Ali, A. B., Khan, N. A., Nguyen, D. T., Chihara, R., Chan, E. Y., Graviss, E. A., ... Kim, M. P. (2020). Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. Surgical Endoscopy, 34(7), 3191-3196. https://doi.org/10.1007/s00464-019-07093-2

Vancouver

Ali AB, Khan NA, Nguyen DT, Chihara R, Chan EY, Graviss EA et al. Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. Surgical Endoscopy. 2020 Jul 1;34(7):3191-3196. https://doi.org/10.1007/s00464-019-07093-2

Author

Ali, Aman B. ; Khan, Najah A. ; Nguyen, Duc T. ; Chihara, Ray ; Chan, Edward Y. ; Graviss, Edward A. ; Dunkin, Brian J. ; Kim, Min Peter. / Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. In: Surgical Endoscopy. 2020 ; Vol. 34, No. 7. pp. 3191-3196.

BibTeX

@article{25249965340947239c9f9b3db23ad5fb,
title = "Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy",
abstract = "Background: Achalasia is an uncommon disease treated by decreasing the lower esophageal sphincter resting pressure. This study compared the safety and efficacy of esophago-gastric myotomy via laparoscopic, robotic, and per-oral endoscopic approaches. Methods: A retrospective review of data on patients with achalasia or other esophageal dysmotility disorder undergoing laparoscopic, robotically assisted, or per-oral endoscopic myotomy (POEM) procedures between 2013 and 2017 was performed. Patient demographics, comorbidities, procedure details, length of stay, 30-day readmission rate, and combined technical complication (full-thickness injury, conversion to open, and delayed perforation) were compared. Multiple logistic regression analysis was performed to determine which factors contributed to combined technical complication. Results: There were 171 patients who underwent esophago-gastric myotomy with 161 (94.2{\%}) having achalasia. There were 40 laparoscopic Heller myotomies with partial fundoplication, 44 robotic Heller myotomies with partial fundoplication, and 87 POEM procedures performed during the study period. Baseline statistical differences were found among the groups in regard to gastroesophageal reflux symptoms, arrhythmia, hypertension, and congestive heart failure. Laparoscopic Heller myotomy had significantly higher combined technical complications (7, 17.5{\%}) compared to robotically assisted Heller myotomy (0, 0{\%}) and POEM (1, 1.1{\%}). Multivariate analysis showed that laparoscopic Heller myotomy (OR 32.22; 95{\%} CI 2.66, 389.83; p = 0.01), myocardial infarction (OR 27.94; 95{\%} CI 1.66, 471.10; p = 0.02), and history of smoking (OR 8.87; 95{\%} CI 1.29, 61.15; p = 0.03) were risks for developing combined technical complications. Conclusion: Robotically assisted Heller myotomy and POEM are safe and efficacious treatments for achalasia with lower rates of technical complications compared to laparoscopic Heller myotomy. With the advancements in endoscopic instruments and robotic surgery, POEM and robotically assisted Heller myotomy should be considered in the treatment of achalasia and esophageal dysmotility disorders.",
keywords = "Achalasia, Esophago-gastric myotomy, Laparoscopic Heller myotomy, POEM, Per-oral endoscopic myotomy, Robotic-assisted Heller myotomy, Surgical approach",
author = "Ali, {Aman B.} and Khan, {Najah A.} and Nguyen, {Duc T.} and Ray Chihara and Chan, {Edward Y.} and Graviss, {Edward A.} and Dunkin, {Brian J.} and Kim, {Min Peter}",
year = "2020",
month = "7",
day = "1",
doi = "10.1007/s00464-019-07093-2",
language = "English (US)",
volume = "34",
pages = "3191--3196",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York",
number = "7",

}

RIS

TY - JOUR

T1 - Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy

AU - Ali, Aman B.

AU - Khan, Najah A.

AU - Nguyen, Duc T.

AU - Chihara, Ray

AU - Chan, Edward Y.

AU - Graviss, Edward A.

AU - Dunkin, Brian J.

AU - Kim, Min Peter

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Background: Achalasia is an uncommon disease treated by decreasing the lower esophageal sphincter resting pressure. This study compared the safety and efficacy of esophago-gastric myotomy via laparoscopic, robotic, and per-oral endoscopic approaches. Methods: A retrospective review of data on patients with achalasia or other esophageal dysmotility disorder undergoing laparoscopic, robotically assisted, or per-oral endoscopic myotomy (POEM) procedures between 2013 and 2017 was performed. Patient demographics, comorbidities, procedure details, length of stay, 30-day readmission rate, and combined technical complication (full-thickness injury, conversion to open, and delayed perforation) were compared. Multiple logistic regression analysis was performed to determine which factors contributed to combined technical complication. Results: There were 171 patients who underwent esophago-gastric myotomy with 161 (94.2%) having achalasia. There were 40 laparoscopic Heller myotomies with partial fundoplication, 44 robotic Heller myotomies with partial fundoplication, and 87 POEM procedures performed during the study period. Baseline statistical differences were found among the groups in regard to gastroesophageal reflux symptoms, arrhythmia, hypertension, and congestive heart failure. Laparoscopic Heller myotomy had significantly higher combined technical complications (7, 17.5%) compared to robotically assisted Heller myotomy (0, 0%) and POEM (1, 1.1%). Multivariate analysis showed that laparoscopic Heller myotomy (OR 32.22; 95% CI 2.66, 389.83; p = 0.01), myocardial infarction (OR 27.94; 95% CI 1.66, 471.10; p = 0.02), and history of smoking (OR 8.87; 95% CI 1.29, 61.15; p = 0.03) were risks for developing combined technical complications. Conclusion: Robotically assisted Heller myotomy and POEM are safe and efficacious treatments for achalasia with lower rates of technical complications compared to laparoscopic Heller myotomy. With the advancements in endoscopic instruments and robotic surgery, POEM and robotically assisted Heller myotomy should be considered in the treatment of achalasia and esophageal dysmotility disorders.

AB - Background: Achalasia is an uncommon disease treated by decreasing the lower esophageal sphincter resting pressure. This study compared the safety and efficacy of esophago-gastric myotomy via laparoscopic, robotic, and per-oral endoscopic approaches. Methods: A retrospective review of data on patients with achalasia or other esophageal dysmotility disorder undergoing laparoscopic, robotically assisted, or per-oral endoscopic myotomy (POEM) procedures between 2013 and 2017 was performed. Patient demographics, comorbidities, procedure details, length of stay, 30-day readmission rate, and combined technical complication (full-thickness injury, conversion to open, and delayed perforation) were compared. Multiple logistic regression analysis was performed to determine which factors contributed to combined technical complication. Results: There were 171 patients who underwent esophago-gastric myotomy with 161 (94.2%) having achalasia. There were 40 laparoscopic Heller myotomies with partial fundoplication, 44 robotic Heller myotomies with partial fundoplication, and 87 POEM procedures performed during the study period. Baseline statistical differences were found among the groups in regard to gastroesophageal reflux symptoms, arrhythmia, hypertension, and congestive heart failure. Laparoscopic Heller myotomy had significantly higher combined technical complications (7, 17.5%) compared to robotically assisted Heller myotomy (0, 0%) and POEM (1, 1.1%). Multivariate analysis showed that laparoscopic Heller myotomy (OR 32.22; 95% CI 2.66, 389.83; p = 0.01), myocardial infarction (OR 27.94; 95% CI 1.66, 471.10; p = 0.02), and history of smoking (OR 8.87; 95% CI 1.29, 61.15; p = 0.03) were risks for developing combined technical complications. Conclusion: Robotically assisted Heller myotomy and POEM are safe and efficacious treatments for achalasia with lower rates of technical complications compared to laparoscopic Heller myotomy. With the advancements in endoscopic instruments and robotic surgery, POEM and robotically assisted Heller myotomy should be considered in the treatment of achalasia and esophageal dysmotility disorders.

KW - Achalasia

KW - Esophago-gastric myotomy

KW - Laparoscopic Heller myotomy

KW - POEM

KW - Per-oral endoscopic myotomy

KW - Robotic-assisted Heller myotomy

KW - Surgical approach

UR - http://www.scopus.com/inward/record.url?scp=85071781036&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071781036&partnerID=8YFLogxK

U2 - 10.1007/s00464-019-07093-2

DO - 10.1007/s00464-019-07093-2

M3 - Article

VL - 34

SP - 3191

EP - 3196

JO - Surgical Endoscopy and Other Interventional Techniques

T2 - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 7

ER -

ID: 52947790