Complications of Heller myotomy
The most common complication of a surgical myotomy is esophageal perforation, which is reported in 0% to 4.6% of patients. Previous pneumatic dilatation and botulinum toxin injection increase the technical difficulty in performing a myotomy and may increase the rate of perforation. Mucosal injuries detected during surgery may be repaired primarily. An unrecognized esophageal perforation may present as persistent fever, tachycardia, or left-sided pleural effusion. These patients require close observation and may need reoperation if conservative measures fail.
Early postoperative dysphagia results usually from an incomplete myotomy, whereas causes of late dysphagia also include healing of the myotomy or, more rarely, a reflux-induced peptic stricture. Incomplete myotomy responds usually to extension of the myotomy. However, in patients in whom the first myotomy was complete, a second myotomy is less likely to be successful and such patients may require esophageal resection.