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Laparoscopic cardiomyotomy with a Dor patch for achalasia
P C Mitchell1, D I Watson, P G Devitt
1Royal Adelaide Centre for Endoscopic Surgery, Royal Adelaide Hospital, South Australia.
Objective:
To evaluate early experience with laparoscopic Heller's cardiomyotomy with placement of a Dor patch for achalasia.
Design:
A prospective case series.
Setting:
A university teaching hospital.
Patients:
Fourteen patients (5 men, 9 women, median age 47 years) with esophageal achalasia, treated between July 1992 and July 1994.
Interventions:
Laparoscopic Heller's cardiomyotomy with a Dor patch.
Main Outcome Measures:
Clinical relief of symptoms, confirmed by esophageal manometry, 24-hour ambulatory pH monitoring and barium-contrast radiography.
Results:
Three of the 14 patients required conversion to an open procedure, and 1 underwent early laparotomy for postoperative bleeding. The median operating time was 120 minutes (range from 75 to 210 minutes), and the median duration of hospitalization was 4 days (range from 3 to 18 days). Normal physical activity was resumed after a median of 2 weeks (range from 0.5 to 6 weeks). Symptomatic dysphagia was completely relieved in 12 patients and improved in 2. Only one patient experienced symptoms of reflux postoperatively. Postoperative esophageal manometry (seven patients), 24-hour pH monitoring (five patients) and barium-meal radiography (seven patients) confirmed the clinical results.
Conclusion:
Laparoscopic Heller's cardiomyotomy with a Dor patch provides a viable alternative to open cardiomyotomy and forceful endoscopic dilatation.