Abstract
Results of an ongoing clinical study treating achalasia patients with a transabdominal laparoscopic Heller myotomy and Toupet partial fundoplication are presented. Twelve patients underwent surgery between January 1992 and October 1993. All patients had barium esophagograms, preoperative endoscopy, esophageal manometry, 24-h pH studies, and extensive GI history preoperatively. Surgical complications included two perforations of the mucosa at the gastroesophageal junction repaired laparoscopically. There were no surgical mortalities and the average hospital stay was 39 h. Postoperatively all patients at follow-up had a repeat GI history, esophagogastroscopy, 24-h pH testing, and esophageal manometry. This follow-up showed good-to-excellent relief of dysphagia in all 12 patients with one patient complaining of heartburn documented to be from reflux postoperatively. Manometry showed a mean decrease in the lower esophageal sphincter pressure from 33.4 mmHg preoperatively to 19.3 mmHg postoperatively; 24-hour pH testing showed no significant reflux in the nine patients who had Heller myotomy plus a Toupet fundoplication. However, two of three patients who had Heller myotomy alone demonstrated abnormal 24-h pH testing. One of these patients was symptomatic and was found to have mild esophagitis by biopsy on postoperative endoscopy. These good results have persisted for mean follow-up of 16 months.
Similar content being viewed by others
References
Crookes PF, Wilkinson AJ, Johnston GW (1989) Heller's myotomy with partial fundoplication. Br J Surg 76: 98–9
Csendes A, Braghetto I, Heriquez A, Cortes C (1988) Late subjective and objective evaluation of the results of esophagomyotomy in 100 patients with achalasia of the esophagus. Surgery 104: 469
Dellipiani AW, Hewetson KA (1986) Pneumatic dilatation in the management of achalasia: Experience of 45 cases. Q J Med 58: 253
DeMeester TR, Stein HJ (1992) Surgery for esophageal motor disorders. In: Castell DO (ed) The esophagus. Little, Brown & Co., Boston, pp 401–439
Earlam R, Andreollo NA (1987) Heller's myotomy for achalasia: is an added antireflux procedure necessary? Br J Surg 74: 765–772
Heller E (1914) Extramukose karkioplastik beim chronisken Kardiospasmus mit Dilatation des Oesophagus. Mitt Grenzgeb Med Chir 27: 141
Mayberry JF, Rhodes J (1980) Achalasia in the city of Cardiff from 1926 to 1977. Digestion 20: 248–252
Okike N, Payne WS (1979) Esophagomyotomy versus forceful dilatation for achalasia of the esophagus: results in 899 patients. Ann Thorac Surg 23: 119
Paricio PP, Martinez de Haro L, Ortiz A, Aguayo J (1990) Achalasia of the cardia: long-term results of oesophagomyotomy and posterior partial fundoplication. Br J Surg 77: 1371–1374
Pellegrini CA, Leichter R, Patti M, Wetter L, Mori T, Way L (1993) Thoracoscopic esophageal myotomy in the treatment of achalasia. Ann Thorac Surg 56: 680–682
Pellegrini CA, Wetter LA, Patti M, Leichter R, Mussan G, Mori T, Bernstein G, Way L (1992) Thoracoscopic esophagomyotomy: initial experience with a new approach for the treatment of achalasia. Ann Surg 216: 291–299
Rosato EF, Acker M, Curcillo PG, Reilly R, Reynolds J (1991) Transabdominal esophagomyotomy and partial fundoplication for treatment of achalasia. Surg Gyn Obstet 173: 137–141
Shimi SM, Nathanson LK, Cuschieri A (1992) Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: initial experience of a new surgical approach. Br J Surg 79: 533–536
Thor K, Silander T (1989) A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. Ann Surg 210: 719–724
Topart P, Deschamps C, Tailefer R, Duranceau A (1992) Long-term effect of total fundoplication on the myotomized esophagus. Ann Surg 54: 1046–1052
Vantrappen G, Hellemans J, Deloof W, Valembois P, Bandenbroucke J (1971) Treatment of achalasia with pneumatic dilations. Gut 12: 268
Wong RK, Maydonovitch CL (1992) Achalasia. In: Castell DO (ed) The esophagus. Little, Brown & Co., Boston, pp 233–260
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Swanstrom, L.L., Pennings, J. Laparoscopic esophagomyotomy for achalasia. Surg Endosc 9, 286–292 (1995). https://doi.org/10.1007/BF00187770
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00187770