Efficacy, safety and long-term follow-up of laparoscopic Heller’s myotomy with anterior fundoplication in Achalasia

Abstract

The primary indication for esophagocardiomiotomy at our institution over the last 12 years has been failure of endoscopic balloon dilation with consequent persistence of dysphagia or intra-procedure viscus perforation. 

In 1996 we began using a laparoscopic approach for esophagocardiomiotomy, thereby offering our patients a minimally invasive alternative to endoscopic dilation.

Materials and Methods: We reviewed the case histories of twenty-three patients who underwent laparoscopic esophagocardiomiotomy with anterior fundoplication between November 1996 and November 2005. Data collected specifically reflected symptoms of the disease, pre-operative work-up and number of prior dilations performed. Patients were asked to respond to a symptom scale that considered the most common presenting complaints of this disorder (dysphagia, regurgitation, chest pain and heartburn) both pre- and post-operatively.

Results: Mean operative time was 111 minutes. Four per-operative complications occurred, two minor lacerations of the splenic capsule, one pneumothorax and one esophageal perforation. An additional patient developed a post-operative esophageal fistula that was managed non-operatively. In this series there were no fatalities or need for conversion to an open procedure.

Mean follow-up was 54.9 ± 29 months. Statistical analyses applied to the symptom scale demonstrated that the p values were significant for all the clinical variables studied.

Conclusion: Laparoscopic esophagocardiomiotomy with anterior fundoplication should be considered, in our opinion, the procedure of choice in the treatment of achalasia.

Keywords: Achalasia – Esophagocardiomiotomy – Laparoscopy.