Laparoscopic esophagomyotomy for achalasia

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and loss of peristalsis.
• Traditional treatments for achalasia include pneumatic dilation, esophagotomy, and esophagectomy, each with potential complications and varying success rates.

Purpose of the Study:

• To evaluate the efficacy and safety of transabdominal laparoscopic Heller myotomy combined with Toupet partial fundoplication for achalasia treatment.
• To assess the impact of this surgical approach on esophageal manometry, 24-hour pH monitoring, and patient-reported dysphagia and reflux symptoms.

Main Methods:

• A prospective clinical study involving 12 achalasia patients undergoing transabdominal laparoscopic Heller myotomy and Toupet partial fundoplication.
• Preoperative and postoperative assessments included barium esophagograms, endoscopy, esophageal manometry, 24-hour pH studies, and gastrointestinal history.
• Surgical outcomes, complications, hospital stay, and long-term follow-up data were meticulously recorded.

Main Results:

• All 12 patients experienced good-to-excellent relief of dysphagia postoperatively, with a mean follow-up of 16 months.
• Mean LES pressure decreased significantly from 33.4 mmHg preoperatively to 19.3 mmHg postoperatively.
• Nine patients who underwent Heller myotomy with Toupet fundoplication showed no significant reflux on 24-hour pH testing; however, two of three patients with Heller myotomy alone had abnormal pH findings.

Conclusions:

• Transabdominal laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment for achalasia, providing significant dysphagia relief and preventing postoperative reflux.
• The addition of a Toupet fundoplication appears crucial in mitigating reflux complications often associated with Heller myotomy alone.