What does this research mean for the field?

Laparoscopic Heller-Dor myotomy is a safe and effective salvage therapy after failed endoscopic treatment for esophageal achalasia, although patients with prior POEM have significantly lower success rates and higher reflux compared to treatment-naïve or prior pneumatic dilation patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the safety and clinical outcomes of laparoscopic Heller–Dor myotomy as a salvage procedure in patients with achalasia after failed endoscopic therapy compared to treatment-naïve patients.

August 22, 2026Surgical EndoscopyOpen Access

Laparoscopic Heller–Dor as salvage therapy after failed POEM: a prospective comparative study

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Authors

IZIrene Sole ZuinUniversity Medical Center Utrecht TGTommaso GarboUniversity of Padua LPLuca ProvenzanoUniversity of Padua

Discussion

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Implication

Prospective comparative study reveals lower success rates and increased reflux with laparoscopic Heller-Dor after failed peroral endoscopic myotomy, indicating higher surgical risk.

Key Points

To evaluate the safety and clinical outcomes of laparoscopic Heller–Dor myotomy as a salvage procedure in patients with achalasia after failed endoscopic therapy compared to treatment-naïve patients.
Prospectively enrolled 577 consecutive patients with esophageal achalasia undergoing laparoscopic Heller–Dor (LHD) between 2020 and 2025, followed for a median of 30 months (IQR: 22–34).
Stratified the study population into three cohorts: treatment-naïve (n=498), prior peroral endoscopic myotomy (POEM, n=15), and prior pneumatic dilation (PD, n=64).
Therapeutic success was significantly lower in the prior POEM group (80.0%) compared with the treatment-naïve group (98.6%) and prior PD group (95.3%) (p < 0.001).
Abnormal postoperative acid exposure occurred significantly more often in the prior POEM group (33.3%, p < 0.01), while mucosal perforation rates were similar across groups (p = 0.65) with zero mortality overall.

Cite This Study

Zuin et al. (2026) studied this question.

synapsesocial.com/papers/6a895f2aca7ade938187daca https://doi.org/10.1007/s00464-026-13278-3

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Implication

Prospective comparative study reveals lower success rates and increased reflux with laparoscopic Heller-Dor after failed peroral endoscopic myotomy, indicating higher surgical risk.

Laparoscopic Heller–Dor as salvage therapy after failed POEM: a prospective comparative study

Discussion

Member takes

Implication

Key Points

Cite This Study

Laparoscopic Heller–Dor as salvage therapy after failed POEM: a prospective comparative study

Discussion

Member takes

Implication

Key Points

Cite This Study

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