Laparoscopic Heller myotomy with fundoplication for achalasia

Background and Purpose: Laparoscopic Heller cardiomyotomy for the treatment of achalasia can be performed safely. The application of this minimally invasive approach has not been reported in Taiwan. This study assessed the results obtained using this new method in Taiwanese patients. Methods: From January 1998 to December 2000, we recruited 10 patients (3 men, 7 women; average age 37.3 yr) with achalasia who underwent laparoscopic cardiomyotomy and fundoplication. Before and after surgery, the severity of three symptoms (dysphagia, regurgitation, chest pain) was evaluated by symptom scores (0 = symptom absent; 1 = occasional; 2 = every day; 3 = every meal). Barium swallow study and panendoscopy were performed in all patients. Esophageal manometry was performed before surgery in seven patients. Laparoscopic Heller myotomy and anterior (Dor) fundoplication was performed through five abdominal trocar sites. The myotomy extended 7 cm, 6 cm above and 1 cm below the gastroesophageal junction. Results: Barium swallow study showed that one-patient had a normal or mildly dilated esophagus (< 3 cm) and nine patients had moderate esophageal dilatation (3-7 cm). Mean operative time was 162.5 ± 29.7 minutes. Mean hospital stay was 5.1 ± 1.6 days (range, 3-9 d). The mean follow-up time was 21.3 ± 9.4 months, longer than 19 months in eight patients. Dysphagia was alleviated in all but one patient (90%). Regurgitation and chest pain also improved in all patients. No intraoperative complication occurred. Postoperative weight gain (> 4 kg) was noted in all patients. Conclusions: Laparoscopic Heller myotomy and anterior fundoplication result in significant symptomatic relief for patients with achalasia.