Esophageal achalasia: laparoscopic Heller cardiomyotomy

A laparoscopic Heller cardiomyotomy technique was used on five patients whose esophageal achalasia was diagnosed clinically, radiologically manometrically. The physiological principles and operational steps are the same as in open surgery. with the patient in an anti-Trendelenburg 30 degrees position and the surgeon between the patient's legs, a CO2 pneumoperitoneum was produced. Five trocars were used. the esophagus was freed by blunt dissection and an 8 cm longitudinal myotomy was made on the anterior surface of the thoracic esophagus starting a few centimetres above the cardias and parallel and to the left of the anterior vagus, the magnified operative field facilitated more precise myotomy. The myotomy incision ended 2 cm from the esophageal-gastric junction. We closed the angle of His before performing a Dor anterior fundoplication with anchorages to the diaphragmatic crura. Mean operation time was 2 hrs 45 min. Intraoperative blood loss was less than 100 ml. In comparison with open-surgery, patients had less postoperative pain, needed only non-narcotic analgesics for the first 12 hrs, and had no unsightly operation scar. patients tolerated liquids between 24 and 48 hrs. Hospitalization time was 3 to 5 days. Long-term follow-up transit studies, manometry, and 24 hrs pH measurements are needed to fully evaluate the technique. At two months, the symptoms of dysphagia had completely disappeared in three patients: the results were qualified as excellent. As some dysphagia for solids remained in the other two, they were qualified as good.