Laparoscopic management of achalasia

Eight patients with achalasia were treated using laparoscopic esophagomyotomy and anterior (Dor) fundoplication. The procedures were done on patients with clinical, radiological, and manometric diagnoses of achalasia. All procedures were completed laparoscopically. Seven (88%) of the patients were eating by the 3rd postoperative day. The average hospital stay was 4.1 days (2-11 days); analgesic use was minimal. All myotomies were complete, with no patient requiring reoperation or dilation. The only complication was a mucosal laceration in one patient; this was successfully repaired laparoscopically. Follow-up from 8 to 20 months shows that swallowing is excellent in 88 per cent and good in 12 per cent of patients, and no patient requires antireflux medication. These results support minimally invasive surgical myotomy as the treatment of choice for symptomatic achalasia.