[Heller's myotomy by laparoscopic approach for megaesophagus]

The development of laparoscopic surgery has allowed the indications of this technique to be extended to the management of achalasia. Four patients were operated for achalasia confirmed by esophageal manometry. The procedure consisted of laparoscopic Heller's myotomy. The purpose of this paper is to detail the technical principles of this procedure and to evaluate its feasibility. There were no intra-operative incident and no conversion to open procedure. The postoperative course was uneventful in every case. The mean postoperative stay was 5 days. The postoperative manometry (n = 3), performed an average of 14.5 months after the operation, showed a normal lower esophageal sphincter pressure in all cases. Only one patient complained of intermittent dysphagia without food restriction and with normal postoperative manometry. The feasibility of laparoscopic Heller's myotomy is therefore obvious. Consequently, this procedure could replace repeated balloon dilatations in the management of achalasia.