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Laparoscopic myotomy for primary esophageal achalasia: prospective evaluation
1Department of General and Digestive Surgery, Hôtel-Dieu, Clermont-Ferrand, France.
Background/Aim:
The feasibility and safety of the laparoscopic myotomy having been previously demonstrated, the purpose of this prospective study was to evaluate its effectiveness.
Materials And Methods:
Eight patients with primary esophageal achalasia underwent a laparoscopic modified Heller's myotomy with a posterior fundoplication. Early post-operative course has been uneventful in all cases. Clinical, endoscopic, and manometric prospective evaluations were performed with a median follow-up of 21 months (range 4-40).
Results:
Excellent or good clinical results were present in all cases. Endoscopic studies were normal in all cases and the post-operative esophageal manometry (n = 7) showed that the median pressure of the lower esophageal sphincter decreased to 8.5 mmHg (range 3-9) which was significant compared to the median pre-operative value of 35 mmHg (p < 0.01).
Conclusion:
Though this experience is limited, these mean-term results suggest that the laparoscopic myotomy is effective to treat achalasia. It combines the efficacy of surgery and the minimally invasive aspect of dilatations. Thus, a prospective controlled trial comparing laparoscopic myotomy and dilatations is needed.