Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery.
A Heller-Dor procedure was performed by laparotomy (group A: n = 8) or by laparoscopy (group B: n = 12) after failure of one to 17 sessions of intraluminal dilatations (n = 13) or as a primary treatment of oesophageal achalasia (n = 7). The oesophagomyotomy was extended over the thoracic oesophagus by thoracoscopy in two patients having vigorous achalasia. Injury to the oesophageal mucosa occurred in two group A patients who had previously been dilated. At follow-up (range: 1 to 113 months), 6 patients of group A (75%) and 10 of group B(83.3%) had no residual dysphagia. The four patients (group A: n = 2; group B: n = 2) who complained of heartburn prior to the operation were asymptomatic, only one group A patient developed symptoms of reflux, and oesophageal pH-monitoring was normal in the 6 group B patients investigated at follow-up. The laparoscopic approach reduces the magnitude of the operation, and the magnified overview permits precise dissection of the intraparietal adhesions which may develop after numerous sessions of dilatation.
Collard
J M
JM
Louvain Medical School, St Luc Academic Hospital, Brussels, Belgium.
Romagnoli
R
R
Lengele
B
B
Salizzoni
M
M
Kestens
P J
PJ
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D004106:Dilatation / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology