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Symptomatic outcome of laparoscopic cardiomyotomy without an antireflux procedure: experience in initial 40 cases
Rajinder Parshad1, Priya Hazrah, Anoop Saraya
1Department of Surgery, All India Institute of Medical Sciences, New Delhi, India. rparshad@yahoo.com
Insights
Laparoscopic cardiomyotomy without an antireflux procedure effectively relieves achalasia cardia symptoms like dysphagia. This surgical approach demonstrates excellent outcomes with minimal persistent heartburn or dysphagia post-operation.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Achalasia cardia treatment aims for symptom relief, primarily dysphagia.
- Laparoscopic cardiomyotomy with an antireflux procedure is commonly studied.
- Data on laparoscopic cardiomyotomy *without* an antireflux procedure is limited.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic cardiomyotomy without an antireflux procedure.
- To assess symptom relief and complication rates in patients undergoing this specific surgical technique.
Main Methods:
- Retrospective analysis of 40 consecutive patients undergoing laparoscopic cardiomyotomy without antireflux procedure.
- Assessment of preoperative symptoms (dysphagia, regurgitation, heartburn) and postoperative outcomes.
- Follow-up at a mean of 26 months to evaluate symptom scores and complications.
Main Results:
- No mortality and only 1 conversion reported.
- Significant improvement in dysphagia and regurgitation scores post-surgery.
- Low rates of persistent dysphagia (5%) and postoperative heartburn (7.5%), both manageable.
Conclusions:
- Laparoscopic cardiomyotomy without an antireflux procedure provides excellent dysphagia relief for achalasia cardia.
- This technique is safe and does not appear to induce significant symptomatic reflux.
- It represents a viable alternative surgical option for achalasia cardia management.
Abstract:
The aim of surgical treatment in achalasia cardia is symptom relief. Most studies have evaluated the results of laparoscopic cardiomyotomy with an antireflux procedure. However, data on the effectiveness of laparoscopic cardiomyotomy without an antireflux procedure is sparse. We describe our experience of laparoscopic cardiomyotomy without antireflux procedure in 40 consecutive patients with respect to symptom relief and complications. There was no mortality and 1 conversion. Preoperatively dysphagia, regurgitation, and heartburn were present in 40, 39, and 11 patients. At a mean follow-up of 26 months, there was a significant improvement in symptom scores. Two patients (5%) had persistent postoperative dysphagia. One improved on conservative therapy, whereas other was treated with relaparoscopic cardiomyotomy. Three patients (7.5%) developed heartburn in the postoperative period, which was well controlled with proton pump inhibitors. Laparoscopic cardiomyotomy without antireflux procedure results in excellent relief of dysphagia without producing significant symptomatic reflux in the follow-up.
