Laparoscopic cardiomyotomy with a Dor patch for achalasia.
OBJECTIVE
To evaluate early experience with laparoscopic Heller's cardiomyotomy with placement of a Dor patch for achalasia.


METHODS
A prospective case series.


METHODS
A university teaching hospital.


METHODS
Fourteen patients (5 men, 9 women, median age 47 years) with esophageal achalasia, treated between July 1992 and July 1994.


METHODS
Laparoscopic Heller's cardiomyotomy with a Dor patch.


METHODS
Clinical relief of symptoms, confirmed by esophageal manometry, 24-hour ambulatory pH monitoring and barium-contrast radiography.


RESULTS
Three of the 14 patients required conversion to an open procedure, and 1 underwent early laparotomy for postoperative bleeding. The median operating time was 120 minutes (range from 75 to 210 minutes), and the median duration of hospitalization was 4 days (range from 3 to 18 days). Normal physical activity was resumed after a median of 2 weeks (range from 0.5 to 6 weeks). Symptomatic dysphagia was completely relieved in 12 patients and improved in 2. Only one patient experienced symptoms of reflux postoperatively. Postoperative esophageal manometry (seven patients), 24-hour pH monitoring (five patients) and barium-meal radiography (seven patients) confirmed the clinical results.


CONCLUSIONS
Laparoscopic Heller's cardiomyotomy with a Dor patch provides a viable alternative to open cardiomyotomy and forceful endoscopic dilatation.
Mitchell
P C
PC
Royal Adelaide Centre for Endoscopic Surgery, Royal Adelaide Hospital, South Australia.
Watson
D I
DI
Devitt
P G
PG
Britten-Jones
R
R
MacDonald
S
S
Myers
J C
JC
Jamieson
G G
GG
D002299:Cardia / Q000601:surgery; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications