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Risks & Possible Complications

Laparoscopic Heller Myotomy
What the published evidence says about risk

This page summarizes the risks of laparoscopic Heller myotomy for achalasia in plain language, using figures reported in large published studies. This is general information, not your individual risk assessment — Dr. Irshad will review your own risk factors with you directly as part of your consent discussion before surgery.

Risks & possible complications

  • Overall complication rate — about 6%, based on a pooled analysis of over 100 studies and nearly 8,000 patients.
  • Death — rare, roughly 0.15–0.7%.
  • Accidental opening of the esophagus or stomach lining during surgery — roughly 1 in 250 to 1 in 50 (0.4–2%). When this happens it is almost always recognized and repaired in the same operation, without changing your longer-term outcome.
  • Reflux afterward — roughly 9% when a wrap (fundoplication) is added at the same time, versus roughly 31% without one. This is why Dr. Irshad routinely adds a partial wrap during this operation.
  • Swallowing improves in more than 90% of patients — this is a very effective operation for achalasia.
  • Need for a repeat procedure (balloon dilation or redo surgery) for symptoms that persist or return — a minority of patients, though the exact rate varies across studies.
Your own risk varies. Perforation risk is higher in patients who have had prior treatment (such as Botox injection or pneumatic dilation) before surgery. Ask Dr. Irshad how your history affects your personal risk.

References

  1. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and Surgical Treatments for Achalasia: A Systematic Review and Meta-Analysis. Ann Surg. 2009;249(1):45–57. PubMed
  2. Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia. Am J Gastroenterol. 2012;107(12):1579–85.
  3. Ataya K, Bsat A, Aljaafreh A, et al. Robot-Assisted Heller Myotomy Versus Laparoscopic Heller Myotomy: A Systematic Review and Meta-Analysis. Cureus. 2023;15(11):e48495.

Common questions about risk

What is the complication rate of Heller myotomy for achalasia?
The overall complication rate is about 6%, based on a pooled analysis of over 100 studies and nearly 8,000 patients.
How often does the esophagus get accidentally perforated during Heller myotomy?
Accidental opening of the esophagus or stomach lining occurs in roughly 1 in 250 to 1 in 50 cases (0.4–2%). It is almost always recognized and repaired during the same operation, without changing your longer-term outcome.
Will I have reflux after Heller myotomy?
Reflux occurs in roughly 9% of patients when a wrap (fundoplication) is added at the same time, versus roughly 31% without one — which is why a partial wrap is routinely added during this operation.
How effective is Heller myotomy for achalasia?
Swallowing improves in more than 90% of patients, making it a highly effective treatment for achalasia.
This page is general information, not medical advice or a consent form. It does not replace the individualized consent discussion you will have with Dr. Irshad, which accounts for your own health, anatomy, and the specific operation planned. If you are experiencing a medical emergency, call 911 or go to your nearest Emergency Department immediately. Published in compliance with the CPSO Advertising Standards Policy.

Questions about your risk?

Dr. Kashif Irshad — Division of Thoracic Surgery, William Osler Health System, Brampton Civic Hospital. Tel: (905) 458-4520 · Fax: (905) 458-4080 · thoracic@williamoslerhs.ca

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