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Thoracoscopic Heller's cardiomyotomy: a new approach for achalasia
J R Monson1, A Darzi, P D Carey
1Academic Surgical Unit, St. Mary's Hospital Medical School, London, England.
Insights
Endothoracoscopic Heller's myotomy effectively treated two patients with esophageal achalasia, resolving swallowing difficulties. Both patients remained asymptomatic during long-term follow-up, demonstrating the procedure's efficacy for achalasia treatment.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Esophageal achalasia is a motility disorder characterized by impaired esophageal peristalsis and LES relaxation, leading to dysphagia.
- Heller's myotomy is a standard surgical procedure for achalasia, with laparoscopic and thoracoscopic approaches being common.
- Endothoracoscopic techniques offer potential advantages in minimally invasive esophageal surgery.
Observation:
- Two patients diagnosed with esophageal achalasia presented with significant swallowing difficulties.
- An endothoracoscopic approach to Heller's myotomy was performed on both patients.
- Clinical follow-up was conducted at 12 and 18 months post-procedure.
Findings:
- Both patients treated with endothoracoscopic Heller's myotomy became asymptomatic regarding their swallowing difficulties.
- The procedure demonstrated successful relief of esophageal obstruction and improved esophageal motility.
- No complications were reported in the immediate or long-term follow-up for these two cases.
Implications:
- Endothoracoscopic Heller's myotomy is a viable and effective treatment option for esophageal achalasia.
- This approach may offer benefits comparable to laparoscopic myotomy, warranting further investigation.
- Additional research is needed to evaluate pulmonary complication rates and compare thoracoscopic versus laparoscopic outcomes in Heller's myotomy.
Abstract:
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.