Laparoscopic Heller myotomy with dor antireflux for achalasia.

ABSTRACT

BACKGROUND: The ideal antireflux procedure following laparoscopic Heller myotomy for achalasia is controversial. The authors present a laparoscopic technique of partial anterior fundoplication to bolster the myotomy. MATERIAL AND METHOD: Between August 2002 and March 2006, 11 patients (eight females and three males; median age, 33 years) underwent a laparoscopic Heller myotomy with bolstering partial anterior fundoplication. The results of the barium swallow and manometry studies were consistent with achalasia. Failed medical treatments included balloon dilation, botulinum injection, and calcium channel blockers, were indications for surgery. RESULTS: The pre-operative weight loss was 9 Kg (range, 3-16) with a mean duration of symptoms of 29 months (range, 12-72). Sixty-three percent (7 of 11) of the patients had undergone pneumatic balloon dilation before surgery. Myotomy was confirmed with endoscopic guidance. Partial anterior fundoplication was performed with the edges of the myotomy on the right and left sides sutured to the stomach, which covered the myotomy. No conversion was required. The mean operative blood loss was 70 mL (range, 30-150). The mean operative time was 3 hours. Patients resumed solids at 2.5 days (range, 2-5). None of the patients had any perioperative or postoperative complications. Follow-up ranged up to 4 years (median, 2). Postoperatively, symptoms of dysphagia (to both solids and liquids), heartburn, odynophagia, regurgitation, and cough were significantly reduced in all patients. CONCLUSION: Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity.