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Updated: Jul 10, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Minimally invasive management of achalasia cardia: results from a single center study
C Palanivelu1, G S Maheshkumar, Kalpesh Jani
1Department of GI & Minimal Access Surgery, Gem Hospital, Pankaja Mill Road, Ramanathapuram, Coimbatore-641045, Tamilnadu, India.
Insights
Laparoscopic cardiomyotomy is a safe and effective treatment for achalasia cardia, with Toupet's fundoplication showing excellent results in 226 patients. This minimally invasive approach significantly improved dysphagia symptoms.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic cardiomyotomy has gained popularity for treating achalasia cardia since its introduction in 1991.
- This study reviews the experience of 226 patients who underwent the procedure.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cardiomyotomy for achalasia cardia.
- To discuss relevant surgical and management issues.
Main Methods:
- Retrospective analysis of 226 patients who underwent laparoscopic cardiomyotomy since 1993.
- Detailed description of preoperative workup, surgical technique (myotomy alone, Dor's, or Toupet's fundoplication), and postoperative management.
Main Results:
- The study included 146 males and 80 females, with a mean age of 36.4 years.
- Dysphagia was eliminated in 88.9% of patients, with an overall morbidity of 4.4% and no mortality.
- Mean follow-up was 4.3 years; 162 patients had Toupet's fundoplication, while 44 had Dor's fundoplication.
Conclusions:
- Laparoscopic cardiomyotomy, particularly with Toupet's fundoplication, is a safe and effective treatment for achalasia cardia.
- Dor's fundoplication is reserved for cases with suspected mucosal injury.
Background:
Since the performance of the first laparoscopic cardiomyotomy for achalasia cardia in 1991, the popularity of the minimally invasive approach for this troublesome disease has been growing. We present our experience of 226 patients who underwent laparoscopic cardiomyotomy and discuss the relevant issues.
Methods:
A retrospective analysis was carried out of 226 patients who have undergone laparoscopic cardiomyotomy since 1993. The preoperative workup, surgical technique, and postoperative management are described.
Results:
Patients included 146 males and 80 females; average age was 36.4 years (range, 6 to 85). Mean duration of symptoms was 1.4 years. Nearly half of the patients (112) had undergone prior pneumatic dilatation. In 20 patients, myotomy alone was done, 44 patients had a Dor's fundoplication, and 162 had Toupet's fundoplication. The average operating time was 96 minutes. Mean postoperative hospital stay was 2.2 days. Dysphagia was eliminated in 88.9% of the patients with an overall morbidity of 4.4% and nil mortality over a mean follow-up of 4.3 years.
Conclusion:
Laparoscopic cardiomyotomy with Toupet's fundoplication is a safe and effective treatment of achalasia cardia. Dor's fundoplication is done selectively, especially when suspicion is present of mucosal injury.
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