Laparoscopic myotomy for primary esophageal achalasia: prospective evaluation.
OBJECTIVE
The feasibility and safety of the laparoscopic myotomy having been previously demonstrated, the purpose of this prospective study was to evaluate its effectiveness.


METHODS
Eight patients with primary esophageal achalasia underwent a laparoscopic modified Heller's myotomy with a posterior fundoplication. Early post-operative course has been uneventful in all cases. Clinical, endoscopic, and manometric prospective evaluations were performed with a median follow-up of 21 months (range 4-40).


RESULTS
Excellent or good clinical results were present in all cases. Endoscopic studies were normal in all cases and the post-operative esophageal manometry (n = 7) showed that the median pressure of the lower esophageal sphincter decreased to 8.5 mmHg (range 3-9) which was significant compared to the median pre-operative value of 35 mmHg (p < 0.01).


CONCLUSIONS
Though this experience is limited, these mean-term results suggest that the laparoscopic myotomy is effective to treat achalasia. It combines the efficacy of surgery and the minimally invasive aspect of dilatations. Thus, a prospective controlled trial comparing laparoscopic myotomy and dilatations is needed.
Slim
K
K
Department of General and Digestive Surgery, Hôtel-Dieu, Clermont-Ferrand, France.
Pezet
D
D
Chipponi
J
J
Boulant
J
J
Mathieu
S
S
D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome