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. 2010 Jan;79(1):16-9.

Laparoscopic cardiomyotomy for achalasia: A single unit study

R Kennedy  1 , C Menezes, J Ahmad, J A Kennedy
Affiliations

Laparoscopic cardiomyotomy for achalasia: A single unit study

R Kennedy et al. Ulster Med J. 2010 Jan.

Abstract

Aims: Achalasia is a rare incurable neuromuscular disorder of the oesophagus. A number of treatment options are available. We reviewed our results of laparoscopic cardiomyotomy over a 30 month period.

Methods: 18 patients with manometric features of achalasia underwent surgery between 2004 and 2006. Pre and postoperative weight and dysphagia scores were recorded (maximum score 45=normal, 0=complete dysphagia). Change in the Body Mass Index (BMI) was measured. Other symptoms (heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance) were scored on a 0-4 scale of increasing severity.

Results: At mean follow up of 16.2 months the mean dysphagia score was significantly improved from 7.5 to 33.9 (p<0.005). BMI was significantly increased from 22.3 to 25.8 kg/m(2) (p<0.05). Scores for heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance were also significantly improved. The average inpatient stay was 3.1 days and average operating time 111 minutes. One mucosal perforation occurred which was repaired intraoperatively. No patients required secondary operative intervention.

Conclusions: Laparoscopic cardiomyotomy is a safe, highly effective, minimally invasive treatment for achalasia.

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Figures

Figure 1
Figure 1
Patient position The patient is positioned supine with legs spread apart.
Figure 2
Figure 2
Extension of the myotomy The split edges of oesophageal sphincter muscle are shown grasped by forceps. The oesophageal mucosa lies between. A plane of cleavage is developed between these two layers.
Figure 3
Figure 3
The competed myotomy This extends into the mediastinum
Figure 4
Figure 4
Anterior fundoplication (Dor patch) The fundus of the stomach is secured to the right crus of the diaphragm with non absorbable stitches.
Figure 5
Figure 5
Dysphagia Score pre and post operatively (p<0.005)
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