ABSTRACT
Mucosal perforation is one of the most serious complications of laparoscopic myotomy which is less common in patients treated via laparotomy. The aim of this study is to evaluate the role of harmonic scalpel as a possible safe method during laparoscopic Heller's cardiomyotomy, which may help in reduction of this complication. Ten consecutive patients with primary achalasia underwent laparoscopic Heller's cardiomyotomy with Dor anterior fundoplication using the harmonic scalpel. The procedures were completed laparoscopically in nine patients. A conversion to an open procedure was required in one patient because of the presence of esophageal diverticulum The main operative time was 156 min. None of the patients had mucosal perforation. One patient developed recurrent dysphagia and treated by pneumatic dilatation. Another patient developed reflux esophagitis with - good response to medical treatment. Cardiac achalasia can be safely treated through laparoscopy with the use of harmonic scalpel. Laparoscopic myotomy has resulted hi shorter patient hospital stay and reduced morbidity, making the procedure an attractive initial option for patients with achalasia