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.