Minimally invasive surgery for achalasia: a 10-year experience

Minimally invasive esophagomyotomy for achalasia has become the preferred surgical treatment; the employment of a concomitant fundoplication with the myotomy is controversial. Here we report a retrospective analysis of 53 patients with achalasia treated with laparoscopic Heller myotomy; fundoplicati...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2004-01, Vol.8 (1), p.18-23
Main Authors: Frantzides, Constantine T, Moore, Ronald E, Carlson, Mark A, Madan, Atul K, Zografakis, John G, Keshavarzian, Ali, Smith, Claire
Format: Article
Language:English
Subjects:
Achalasia
Adult
Aged
Clinical trials
Dysphagia
Esophageal Achalasia - surgery
esophagomyotomy
Female
Fundoplication
gastroesophageal reflux
Humans
Laparoscopy
Male
Middle Aged
minimally invasive surgery
Retrospective Studies
Treatment Outcome
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Description
Summary:Minimally invasive esophagomyotomy for achalasia has become the preferred surgical treatment; the employment of a concomitant fundoplication with the myotomy is controversial. Here we report a retrospective analysis of 53 patients with achalasia treated with laparoscopic Heller myotomy; fundoplication was used in all patients except one, and 48 of the fundoplications were complete (floppy Nissen). There were no deaths or reoperations, and minor complications occurred in three patients. Good-to-excellent long-term results were obtained in 92% of the subjects (median follow-up 3 years). Two cases (4%) of persistent postoperative dysphagia were documented, one of which was treated with dilatation. Postoperative reflux occurred in five patients, four of whom did not receive a complete fundoplication; these patients were well controlled with medical therapy. We suggest that esophageal achalasia may be successfully treated with laparoscopic Heller myotomy and floppy Nissen fundoplication with an acceptable rate of postoperative dysphagia.
ISSN:1091-255X
1873-4626
DOI:10.1016/j.gassur.2003.09.021