Laparoscopic heller myotomy with fundoplication for achalasia

ABSTRACT

To determine the results of laparoscopic Heller myotomy with complete or partial fundoplication for the treatment of achalasia and evaluating its longterm benefits and complications. The study was performed retrospectively and prospectively, including all patients with achalsia who where treated by laparoscopic Heller myotomy with fundoplication in Al Assad University Hospital in Damascus between 2005 and 2008. Data was collected from the files of the patients and included symptoms, diagnostic studies, previous therapeutic interventions, surgical treatment, in addition to the results and complications of therapy. Twenty one patients have undergone laparoscpic Heller myotomy with fundoplication. The average age was 32 years, and the dysphagia score was 7 points on average. The median pressure in the lower esophageal sphincter was 35 mmHg. Five patients [24%] had previous therapeutic interventions which included balloon dilatation and botox injection; all of them have suffered recurrence. Laparoscpic Heller myotomy with fundoplication was eventually performed in all patients. The antireflux procedure was Nissen fundoplication in five patients [24%] and Dor anterior fundoplication in 16 patients [76%]. Intraoperative esophageal mocusal perforation has occurred in 5 patients [24%], and one patient [5%] experienced postoperative gastroesophageal reflux. The dysphagia score has dropped to 2-3 points in all patients. No relation was seen between the degree of clinical improvement and the technique used in fundoplication. Laparoscpic Heller myotomy with Dor anterior fundoplication represents the procedure of choice for treatment of achalasia, regardless of previous therapeutic interventions. This operation will control the symptoms and prevent the gastroesophageal reflux with minimal complications