title: Laparoscopic surgical treatment of achalasia.
abstract: BACKGROUND
  The authors have performed 11 myotomies in 10 patients (aged 12 to 77) with achalasia using minimally invasive techniques.
  
  
  METHODS
  The initial 3 patients were treated via transthoracic approach; the subsequent 7 patients via transabdominal approach. The length of the myotomy was determined in conjunction with intraoperative endoscopy to facilitate dissection and demonstrate division of the lower esophageal sphincter.
  
  
  RESULTS
  Only 1 patient required intravenous and intramuscular narcotics more than 24 hours postoperatively; 2 patients required no postoperative narcotics. The average hospital stay for those patients successfully treated endoscopically averaged 2.0 +/- 0.5 days (range 1.5 to 3). One patient was converted to open thoracotomy secondary to perforation of the mucosa. One patient required repeat laparoscopic myotomy at 3 months due to recurrent dysphagia. Follow-up conducted at clinic visits showed all patients to have benefitted with relief of dysphagia; 80% (8) reported excellent results, 10% (1) reported good results, and 10% (1) fair results.
  
  
  CONCLUSIONS
  We converted from thoracic to laparoscopic myotomy because the abdominal approach simplified anesthetic and surgical management. We conclude that laparoscopic myotomy is a simple and effective treatment of achalasia.
authors.affiliation: Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Holzman
authors.forename: K W
authors.initials: KW
authors.lastname: Sharp
authors.forename: J K
authors.initials: JK
authors.lastname: Ladipo
authors.forename: R F
authors.initials: RF
authors.lastname: Eller
authors.forename: G W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: W O
authors.initials: WO
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged