Abstract
Introduction
The pathophysiology, diagnosis, and treatment options for achalasia are briefly discussed, followed by a description of the minimally invasive surgical approaches to this disease, as practiced by the authors.
Summary
Laparoscopic myotomy is performed routinely at our institution in the lithotomy position under endoscopic control. The techniques for performing the myotomy, the use of fundoplication, and the adaptation of this approach to use the surgical robot are described. Laparoscopic esophagomyotomy has been highly effective, durable, safe, and widely accepted by patients. There is less data about the robotic approach, but increased degrees of freedom afforded by articulation in the instruments promises finer control and possibly lower perforation rates.
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References
Speiss A, Kahrilas PJ. Treating achalasia: From whalebone to laparoscope. JAMA 1998;280(7):638–642. doi:10.1001/jama.280.7.638.
Little AG. Functional disorders of the esophagus. In Zuidema G, Yeo C, eds. Surgery of the Alimentary Tract, 5th ed. Oxford: W.B. Saunders, 2002, pp 271–287.
Hirano I, Tatum RP, Shi G, Sang Q, Joel RJ, Kahrilas PJ. Alimentary tract: Manometric heterogeneity in patients with idiopathic achalasia. Gastroenterology 2001;120:789–798. doi:10.1053/gast.2001.22539.
Seelig MH, Devault KR, Seelig SK, Klinger PHJ, Branton SA, Floch NR, et al. Treatment of achalasia: Recent advances in surgery. J Clin Gastroenterol 1999;28(3):202–207. doi:10.1097/00004836-199904000-00004.
Guardino JM, Vela MF, Connor JT, Richter JE. Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol 2004;38(10):855–860. doi:10.1097/00004836-200411000-00004.
Bansal R, Nostrant TT, Scheiman JM, Koshy S, Barnett JL, Elta GH, et al. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol 2003;36(3):209–214. doi:10.1097/00004836-200303000-00005.
Ancoma E, Anselmino M, Zaninotto G, et al. Esophageal achalasia: Laparoscopic versus conventional open Heller–Dor operation. Am J Surg 1995;170(3):265–270. doi:10.1016/S0002-9610(05)80012-1.
Decanini TC, Varela GG, Galicia JA. Laparoscopic esophagomyotomy and antireflux procedure with intraoperative manometry. Surg Laparosc Endosc 1996;6(5):398–402. doi:10.1097/00019509-199610000-00014.
Holzman MD, Sharp KW, Ladipo JK, et al. Laparoscopic surgical treatment of achalasia. Am J Surg 1997;173(4):308–311. doi:10.1016/S0002-9610(96)00398-4.
Rosati R, Fumagalli U, Bonavina L, et al. Laparoscopic approach to esophageal achalasia. Am J Surg 1995;169(4):424–427. doi:10.1016/S0002-9610(99)80190-1.
Vogt D, Curet M, Pitcher D, et al. Successful treatment of esophageal achalasia with laparoscopic Heller myotomy and Toupet fundoplication. Am J Surg 1997;174(6):709–714. doi:10.1016/S0002-9610(97)00197-9.
Wang PC, Sharp KW, Holzman MD, et al. The outcome of laparoscopic Heller myotomy without antireflux procedure in patients with achalasia. Am Surg 1998;64(6):515–520.
Villegas L, Rege RV, Jones DB. Laparoscopic Heller myotomy with bolstering partial posterior fundoplication for achalasia. J Laparoendosc Adv Surg Tech Part A 2003;13(1):1–4.
Raiser F, Perdikis G, Hinder RA, Swanstrom LL, Filipi CJ, McBride PJ, Katada N, Neary PJ. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg 1996; 131(6):593–597 (discussion 597–8).
Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO. 100 consecutive minimally invasive Heller myotomies: Lessons learned. Ann Surg 2002;235(5):631–639. doi:10.1097/00000658-200205000-00004.
Tatum RP, Kahrilas PJ, Manka M, Joehl RJ. Operative manometry and endoscopy during laparoscopic Heller myotomy. Surg Endosc 1999;13:1015–1020. doi:10.1007/s004649901159.
Shiino Y, Filipi CJ, Awad ZT, Tomonaga T, Marsh RE. Surgery for achalasia. J Gastrointest Surg 1999;3(5):447–455. doi:10.1016/S1091-255X(99)80096-1.
Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, et al. Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation. Ann Surg 2005;241(5):725–735. doi:10.1097/01.sla.0000160702.31452.d5.
Chapman JR, Joehl RJ, Murayama KM, Tatum RP, Shi G, Hirano I, et al. Achalasia treatment: Improved outcome of laparoscopic myotomy with operative manometry. Arch Surg 2004;139:508–513. doi:10.1001/archsurg.139.5.508.
Raiser F. Heller myotomy via minimal-access surgery: An evaluation of antireflux procedures. Arch Surg 1996;131:593–598.
Melvin WS, Dundon JM, Talamini M, Horgan S. Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy. Surg 2005;138:553–559. doi:10.1016/j.surg.2005.07.025.
Horgan S, Galvani C, Gorodner MV, Omelanczuk P, Elli F, Moser F, Durand L, Caracoche M, Nefa J, Bustos S, Donahue P, Ferraina P. Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: Multicenter study. J Gastrointest Surg 2005;9:1020–1030. doi:10.1016/j.gassur.2005.06.026.
Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia (a prospective randomized double-blind clinical trial). Ann Surg 2004;240:405–415. doi:10.1097/01.sla.0000136940.32255.51.
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Rivas, H., Rege, R.V. Laparoscopic Esophagomyotomy for Achalasia: How I Do It. J Gastrointest Surg 13, 542–549 (2009). https://doi.org/10.1007/s11605-008-0574-z
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DOI: https://doi.org/10.1007/s11605-008-0574-z