Thoracoscopic Heller's cardiomyotomy: a new approach for achalasia

The authors performed Heller's myotomy using an endothoracoscopic technique on two patients with swallowing difficulties that were clinically demonstrated to be oesophageal achalasia. At 12 and 18 months' followup, respectively, both patients were asymptomatic. Extramucosal cardiomyotomy, as reported by Heller in 1913, is the most common approach to repair achalasia of the oesophagus. The advantages of the laparoscopic technique (less pain, small scars, reduced hospital stay) are given, as well as the disadvantages (possible mobilization of left lateral liver segment, possible splenic damage, difficulty retracting abdominal contents). More studies are needed to determine the rate of pulmonary complications caused by the extended degree of pulmonary collapse in the thoracoscopic approach and to compare the laparoscopic and thoracoscopic approaches to Heller's myotomy.