Laparoscopic surgical treatment of achalasia.
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.
Holzman
M D
MD
Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Sharp
K W
KW
Ladipo
J K
JK
Eller
R F
RF
Holcomb
G W
GW
Richards
W O
WO
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged