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Laparoscopic Heller's cardiomyotomy and Dor's fundoplication for esophageal achalasia
E Xynos1, G Tzovaras, I Petrakis
1Department of General Surgery, University Hospital of Heraklion, Medical School, University of Crete, Greece.
Insights
Laparoscopic Heller's myotomy with Dor's fundoplication effectively treats esophageal achalasia, offering symptom relief and improved patient tolerance compared to open surgery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Esophageal achalasia is a motility disorder characterized by dysphagia.
- Pneumatic dilatation may be ineffective for long-standing achalasia symptoms.
- Surgical interventions aim to relieve lower esophageal sphincter pressure.
Purpose of the Study:
- To evaluate the functional outcomes of laparoscopic Heller's myotomy and Dor's fundoplication.
- To assess the feasibility and safety of this minimally invasive approach for achalasia.
Main Methods:
- Four male patients with achalasia underwent laparoscopic Heller's myotomy and Dor's fundoplication.
- Esophagogram, esophageal manometry, and 24-h esophageal pH monitoring were used for assessment.
- Myotomy was performed after esophageal distension.
Main Results:
- Dysphagia was resolved in all patients at 1 year postoperatively.
- No gastroesophageal reflux symptoms were reported.
- Lower esophageal sphincter pressure significantly decreased post-surgery (56 to 5 mm Hg).
- One patient experienced a manageable esophageal mucosal leak.
Conclusions:
- Laparoscopic Heller's myotomy with Dor's fundoplication is a feasible treatment for esophageal achalasia.
- The procedure yields results comparable to open surgery with enhanced patient tolerance.
- Minimally invasive approach offers significant functional improvement for achalasia patients.
Abstract:
The study's aim was to assess the functional results of laparoscopically performed Heller's myotomy and Dor's fundoplication in our first few cases of esophageal achalasia. Four male patients (mean age: 61 years) with long-standing symptoms of achalasia (documented on esophagogram and esophageal manometry) and not responding to several sessions of pneumatic dilatation, had laparoscopic Heller's myotomy and Dor's fundoplication. Myotomy was facilitated by distending the esophagus. The mean duration of the operation was 99 min. The third patient developed a leak from the exposed esophageal mucosa on the 5th postoperative day while at home. The leak was attributed to late desloughing of a mucosal burn, and was sealed spontaneously 15 days later after drainage. The remaining three patients were discharged after resuming diet within the first 2 postoperative days. By 1 year postoperatively, dysphagia was abolished in all cases, and there were no gastroesophageal reflux symptoms. The esophagogram showed no reflux, which was also confirmed on ambulatory 24-h esophageal pH measurement. On manometry, lower esophageal sphincter (LES) pressure dropped significantly postoperatively (preop: 56 +/- 7 SD mm Hg, postop: 5 +/- 1 SD mm Hg, p < 0.001). In conclusion, laparoscopic Heller's myotomy with Dor's fundoplication for esophageal achalasia is a feasible procedure, offering clinical and laboratory results similar to the open approach, but with better patient tolerance.