Abstract
Purpose: The aim of this study was to evaluate the general properties, surgical techniques and complications of laparoscopic Heller myotomy in surgical treatment of achalasia including our clinical experience.
Patients and Methods: Eight patients who underwent laparoscopic Heller myotomy in Ministry of Health Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital 3rd General Surgery Clinic between May 1999 and December 2004 were examined retrospectively.
Results: Six female and two male patients were included in this study. The mean age was 42.33 (range 19-57). All patients had dysphagia and all had increased lower osephageal resting pressure. Six patients were treated by laparoscopic Heller myotomy, other two patients were treated by laparoscopic Heller myotomy adding Toupet anti reflux procedure. There was no conversion to open surgery. Mucosal perforation occurred in one patient and it was treated by laparoscopic suturing techniques. The mean operation time was 95 minutes (range 56-160). Oral liquid food intake was allowed on the second day of the operation. The mean duration of hospital stay was 3.2 days (range 2-5).
Conclusion: Laparoscopic surgery and laparoscopic Heller myotomy is a more preferable and effective procedure in surgical treatment of achalasia because of reduced duration of hospital stay, increased patient comfort during the surgical procedure, improved cosmetic results and gives patient early return to normal activity and social life .
Keywords:
Laparoscopy, Heller myotomy, surgical techniques, osephagus
References
1Richter JE, Bradley JA, Castell DO. Osephageal chest pain, current controversies in pathogenesis, diagnosis and treatment. Ann Int Med, 1989;110:66-78.
2Howard PJ, Maher L, Pryde A et al. Five-year prospective study of the incidence, clinical features and diagnosis of achalasia in Edinburgh. Gut, 1992;33:1011-1015.
3Wong RK, Maydonovitch CL, Metsz SJ et al. Significant DQw1 association in achalasia. Dig Dis Sci, 1989;34:349-352.
4Pinotti HW, Felix VN, Zilberstein B. et al. Surgical complications of Chaga's disease: Mega-esophagus, achalasia of the pylorus and cholelithiasis. World J Surg, 1991;15:198-204.
5Abir F, Modlin I, Kidd M et al. Surgical treatment of achalasia: Current status and controversies. Dig Surg, 2004;21:165-176.
6Cuilliere C, Ducrotte P, Zerbib F, et al. Achalasia: Outcome of patients treated with intrasphinteric injection of botulinum toxin. Gut, 1997;41:87-92.
7Mikaeli J, Fazel A, Montazeri G et al. Rando-mized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of primary achalasia. Aliment Pharmacol Ther, 2001;15:1389-1396.
8Wehrmann T, Jacobi V, Jung M et al. Pneumatic dilatation in achalasia with a low compliance balloon: Results of a 5 year prospective evaluation. Gastrointest Endosc, 1995;42:31-36.
9Anselmino M, Perdikis G, Hinder RA, et al. Heller myotomy is superior to dilatation for the treatment of early achalasia. Arch Surg, 1997;132:233-240.
10Heller E. Extramucose Cardioplastie beim ahronischen Cardiospasmus mit Dilatation des Osephagus. Mitt Grengeb Chir, 1913;2:141-9.
11Okike N, Payne WS, Neufeld DM, et al. Eso-phagomyotomy versus forceful dilatation for achalasia of the esophagus: results in 899 patients. Ann Thorac Surg, 1979;28:119-125.
12Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb, 1991;36:152-154.
13Patti MG, Diener U, Pellegrini CA. Laparoscopic Esophageal Mytomy. In: editors Bruce V MacFadyen et al. Laparoscopic surgery of the abdomen. Springer, 2003:31-38.
14Alves A, Pernieeni T, Godeberg P, et al. Laparoscopic Heller's cardiomyotomy in achalasia. Is intraoperative endoscopy useful and why ? Surg Endosc, 1999;13:600-603.
15Patti MG, Pellegrini CA, Horgan S. et al. Minimally invasive surgery for achalasia. An 8 year experience with 168 patients. Ann Surg, 1999;230:587-594.
16Bonovina L, Rosati R, Segalin A et al. Laparoscopic Heller-Dor operation for the treatment of esophageal achalasia: Technique and early results. Ann Chir Gynaecol, 1995;80:332-335.
17Anselmino M, Zaninotto G, Costantini M et al. One-year follow-up after laparoscopic Heller-Dor operation for esophageal achalasia. Surg Endosc, 1997;11:3-7.
18Patti MG, Pellegrini CA, Arcerito M et al. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorder. Arch Surg, 1995;130:609-616.
19Hunter JG, Trus TL, Branum GD et al. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg, 1997;225:655-665.
20Sharp KW, Khaitan L, Scholz S et al. 100 consecutive minimally invasive Heller myotomies: Lessons learned. Ann Surg, 2002;235:631-639.
21Oelschlager BK, Chang L, Pellegrini CA: Improved outcome after extended gastric myotomy for achalasia. Arch Surg, 2003;17:153-156.
22Avtan L, Avcı C, Guvenc H et al. Laparoscopic myotomy for oesophageal achalasia-adding antireflux procedure is not always necessary: Int J Clin Pract, January 2005;59.1:35-38.
23Balaji NS, Peters JH. Minimally invasive surgery for esophageal motility disorders. Surg, Clin N Am, 2002;82:763-782.
