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[Mega-esophagus: treatment by celioscopic approach]
J P Arnaud1, C Casa, G Becouarn
1Service de Chirurgie viscérale, CHU d'Angers.
Insights
Laparoscopic Heller's procedure effectively treats achalasia, a swallowing disorder, in patients unresponsive to other methods. This minimally invasive approach offers improved visualization and potentially fewer risks compared to open surgery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Context:
- Achalasia is a rare esophageal motility disorder characterized by dysphagia.
- Traditional treatments for achalasia include endoscopic dilatation and open surgical myotomy.
- Heller's procedure is a standard surgical treatment for achalasia.
Purpose:
- To evaluate the feasibility and outcomes of laparoscopic Heller's procedure for achalasia.
- To assess the efficacy of a modified laparoscopic Heller's procedure with fundoplication in preventing reflux.
- To compare the risks and benefits of laparoscopic versus open Heller's procedure.
Summary:
- Three patients with refractory achalasia underwent laparoscopic Heller's procedure.
- A modification involving anterior fundoplication to the diaphragmatic pillar was performed to mitigate reflux.
- The procedure was technically successful with no reported complications, leading to good patient outcomes.
Impact:
- Laparoscopic Heller's procedure demonstrates a safe and effective alternative to open surgery for achalasia.
- The modified technique may reduce the incidence of post-operative gastroesophageal reflux.
- This approach highlights the potential for laparoscopy to become the preferred method for achalasia treatment.
Abstract:
Heller's procedure is widely used as the most appropriate method for treating achalasia. We performed the procedure laparoscopically in three patients with good results. Two females and one male, age 40, 60 and 68 years, presented with long-term recurrent dysphagia due to achalasia which did not respond to endoscopic dilatation. Heller's procedure was performed laparoscopically in all three with no particular difficulty. In our cases we also attached the anterior border of the greater curvature to the left side of the myotomy and fixed it to the right diaphragmatic pillar to reduce reflux. The procedure would appear to have less risks than laparotomy since visualization of the operative fields is better. Laparoscopy will undoubtedly become the preferred procedure for achalasia.