Laparoscopic Heller Myotomy and Toupet Fundoplication for Achalasia

J Laparoendosc Adv Surg Tech A. 2020 Jun;30(6):630-634. doi: 10.1089/lap.2020.0158. Epub 2020 May 11.

Abstract

Achalasia manifests as failure of relaxation of the lower esophageal sphincter resulting in dysphagia. Although there are several medical and endoscopic treatment options, laparoscopic Heller myotomy has excellent short- and long-term outcomes. This article describes in detail our surgical approach to this operation. Key steps include extensive esophageal mobilization, division of the short gastric vessels, mobilization of the anterior vagus nerve, an extended gastric myotomy (3 cm as opposed to the conventional 1-2 cm gastric myotomy), a minimum 6 cm esophageal myotomy through circular and longitudinal muscle layers, and a Toupet partial fundoplication. We routinely use intraoperative endoscopy both to check for inadvertent full-thickness injury and to assess completeness of the myotomy and the geometry of the anti-reflux wrap.

Keywords: Heller myotomy; Toupet fundoplication; achalasia.

MeSH terms

  • Deglutition Disorders / surgery*
  • Esophageal Achalasia / surgery*
  • Esophageal Sphincter, Lower
  • Esophagoplasty
  • Fundoplication / methods*
  • Gastroesophageal Reflux / surgery
  • Heller Myotomy / methods*
  • Humans
  • Laparoscopy / methods*
  • Myotomy
  • Postoperative Period
  • Treatment Outcome