Perioperative Safety and Effectiveness of Laparoscopic Heller Myotomy in Elderly Patients: Systematic Review and Meta-Analysis

Background: The role of laparoscopic Heller myotomy (LHM) in elderly patients remains controversial due to concerns regarding safety and morbidity. This study aimed to evaluate the perioperative safety and effectiveness of LHM in elderly patients. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed and Cochrane databases were searched for studies reporting outcomes of LHM in patients aged 65 years or older. The primary endpoint was perioperative safety, including intraoperative complications, overall morbidity, and mortality. Secondary endpoints were dysphagia improvement and reintervention. A meta-analysis of proportions was performed to calculate weighted pooled estimates with 95% CIs. Results: A total of 6 studies, including 275 patients, were analyzed. The mean age of patients was 76 (65 to 97) years. The mean follow-up across studies was 32 months. Intraoperative complications occurred in 6% (95% CI: 1%-24%), all mucosal perforations, and conversion to open surgery was required in 4% (95% CI: 1%-11%). The overall morbidity rate was 8% (95% CI: 3%-20%), and no perioperative mortality was reported. Dysphagia improvement was achieved in 96% of patients (95% CI: 26%-100%), with the need for postoperative reintervention in only 14% (95% CI: 5%-33%) of patients at a mean interval of 17.6 months (79.4% endoscopic procedures and 20.6% surgical interventions). Conclusions: Laparoscopic Heller myotomy is safe and highly effective in elderly patients with achalasia. Surgical treatment should be considered as a first-line therapy in those without prohibitive surgical risks.