PD03.05. Comparison of Laparoscopic and Robotic Heller Myotomy With Fundoplication for Achalasia Treatment: A Randomized Clinical Trial - Preliminary Results

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ID: 325912
2026
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Abstract
Abstract Topic Benign Disease: Esophageal Surgery Background Achalasia is an esophageal motor disorder characterized by impaired lower esophageal sphincter relaxation and aperistalsis, often associated with Chagas disease in Brazil. Heller myotomy with fundoplication is the gold standard treatment. However, randomized trials comparing laparoscopic and robotic approaches regarding the main postoperative aspects remain scarce in the literature. Methods This open-label randomized controlled trial is conducted at a Brazilian hospital. In this study 60 patients are enrolled (2:1 allocation: 40 laparoscopic vs. 20 robotic). Inclusion criteria: achalasia, Eckardt score ≥3, and age 18–65. Exclusion criteria: BMI >30 kg/m 2, pregnancy, previous hiatal surgery, or contraindications to laparoscopy. An independent coordinator performs randomization via a software program. Both groups undergo Heller-Pinotti surgery, consisting of an anterior long cardiomyotomy and a three-row postero-latero-anterior partial fundoplication. The study adheres to the Declaration of Helsinki, with Institutional Review Board approval. All participants provided written informed consent, and data anonymity is guaranteed. The primary outcome is surgical success, defined as an Eckardt score <3 at 12-month follow-up, and the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) scale. Secondary outcomes include operative complications (bleeding, mucosal perforation, or organ injury), length of hospital stay, postoperative pain, operative time, and direct medical costs. Results The study analyzed clinical and surgical parameters for patients undergoing Heller-Pinotti myotomy. Preliminary results are presented in this abstract. Clinical success was quantified using the postoperative Eckardt score, which yielded a mean of 0.22 in the robotic-assisted group (n=18) and 0.30 in the laparoscopic group (n=20). Postoperative gastroesophageal reflux and health-related quality of life, the GERD-HRQL scale was applied during the initial follow-up period. The robotic cohort presented a mean score of 1.0 (n=17), whereas the laparoscopic cohort showed a mean score of 1.4 (n=20). Surgical duration was specifically compared using the total operative time recorded in the surgical database (Column K). The mean operative time for the robotic-assisted procedures was 197.2 minutes (n=9), while the mean time for the conventional laparoscopic procedures was 146.6 minutes (n=18). All patients reported high levels of satisfaction with the surgical outcomes during the follow-up consultations conducted at the tertiary center. Conclusion These preliminary results indicate that both surgical modalities are highly effective for achalasia treatment, providing significant clinical improvement and satisfactory reflux control, despite the longer operative duration observed in the robotic-assisted cases. Both laparoscopic and robotic Heller-Pinotti myotomy demonstrate comparable short-term clinical outcomes and anti-reflux efficacy. The robotic platform remains a viable and safe alternative to the conventional laparoscopic approach, although further long-term data are required to assess its cost-effectiveness and late outcomes.
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Authors Arthur Youssif Mota Arabi, Sérgio Szachnowicz, Edno Tales Bianchi, Ary Nasi, Camila Maria de Câmara, Ricardo Zugaib Abdalla, Rubens Antônio Aissar Sallum, Ulysses jr Ribeiro, Paulo Herman
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.091
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.091/70760312/doag077.091.pdf
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