The calibrated laparoscopic Heller myotomy with fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Motility Disorders

Background:

• Esophageal achalasia is a primary esophageal motor disorder.
• Laparoscopic Heller myotomy with fundoplication is the standard treatment, with a 90% success rate.
• 10% of patients experience persistent or recurrent dysphagia due to inadequate myotomy.

Purpose of the Study:

• To evaluate the impact of laparoscopic Heller myotomy on the esophago-gastric junction.
• To assess modifications in LES pressure (LES-P) using computerized manometry.
• To correlate myotomy calibration with surgical outcomes in achalasia patients.

Main Methods:

• 105 achalasia patients underwent laparoscopic calibrated Heller myotomy and antireflux surgery (2002-2010).
• Myotomy length: ≥2.5 cm esophagus, ≥3 cm gastric side.
• Intraoperative manometry and endoscopy were used for calibration of myotomy and fundoplication.

Main Results:

• Preoperative mean LES-P was 37.73 ± 12.21.
• Esophageal and gastric myotomy resulted in a mean pressure drop of 21.3% and 91.9%, respectively.
• No mortality was reported in the study cohort.

Conclusions:

• Laparoscopic calibrated Heller myotomy with fundoplication offers good outcomes for achalasia.
• Intraoperative manometry is crucial for adequate myotomy calibration.
• Accurate calibration prevents overly long esophageal or short gastric myotomies, reducing surgical failure.