Related Experiment Videos
Heller's myotomy: thoracoscopic or laparoscopic?
1St Vincent's Hospital and Box Hill Hospital, Melbourne, Australia.
Insights
Thoracoscopic and laparoscopic myotomy are equally effective for achalasia treatment. Both minimally invasive approaches offer similar safety profiles and symptom relief for dysphagia, with comparable recovery times and outcomes.
Area of Science:
- Minimally Invasive Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Achalasia is a rare esophageal motility disorder.
- Myotomy is a standard surgical treatment for achalasia.
- Minimally invasive techniques are increasingly preferred.
Purpose of the Study:
- To compare the efficacy and safety of thoracoscopic myotomy versus laparoscopic myotomy for achalasia.
- To evaluate long-term outcomes, including dysphagia and reflux symptoms.
Main Methods:
- Prospective study of 36 patients with achalasia.
- 18 patients underwent thoracoscopic myotomy, 18 underwent laparoscopic myotomy.
- Patients were followed for at least 2 years.
Main Results:
- No significant difference in operating time, conversion rates, or hospitalization length.
- Similar rates of dysphagia relief: 14/17 thoracoscopic vs. 18/19 laparoscopic.
- Comparable safety profiles with minimal need for proton pump inhibitors for reflux.
Conclusions:
- Thoracoscopic and laparoscopic myotomy are equally effective for achalasia.
- Both approaches provide similar symptom relief and safety.
- Minimally invasive myotomy without fundoplication is a viable treatment option.
Abstract:
Cardiomyotomy is now usually performed using a minimally invasive approach. A consecutive series of 18 patients with an intention to treat thoracoscopically were followed by the same number of patients treated laparoscopically. Both groups have been followed prospectively for a minimum of 2 years. The groups were well matched for age, symptom duration, preoperative lower esophageal sphincter pressure, and number having undergone balloon dilatation. There was one conversion from a thoracoscopic to a laparoscopic approach so that, for the purpose of analysis, there are 17 in the thoracoscopic group and 19 in the laparoscopic group. There was no difference in the average operating time, rate of conversion to open operation, mucosal breaches, or length of hospitalization. Nor was there any difference in dysphagia symptoms, with 14/17 having a satisfactory result after thoracoscopic myotomy and 18/19 after laparoscopic myotomy. Frequency of reflux symptoms was similar and, although mild reflux was common, only two patients required treatment with a proton pump blocker. In the treatment of achalasia, thoracoscopic and laparoscopic myotomy without fundoplication are equally effective in relieving dysphagia and have a similar safety profile.