Surgical management and outcome in achalasia cardia

The objective of the evidence based clinical report was to assess the outcome of exramucosal modified Heller's cardiomyotomy in terms of effective palliation of dysphagia with minimum complications. Ten patients were included after exclusion of four patients due to poor follow-up. Due to the non-availability of manometry, barium swallow and endoscopy had to be relied upon for the definitive diagnosis. All patients underwent transabdominal modified Heller's myotomy coupled with anterior partial fundoplication (Dor Patch). Median age of the patients treated was 42.5 years. Seven patients had grade III dysphagia, 2 had grade IV and one patient, an 8 years old child was having grade II dysphagia. In one patient, (10%), mucosa was perforated iatrogenically followed by wound infection. Another patient developed acute coronary syndrome on first postoperative day. In the rest of patients recovery was uneventful. Mean hospital stay was 7.1 days. Immediate relief of dysphagia was noted in all the patients. Mean follow-up was 7.2 months. There was significant improvement in dysphagia following surgery. Outcome was assessed devising a scoring system. Excellent outcome was observed in 80% of cases, good in 10% and fair in 10% of cases.