title: Laparoscopic myotomy without fundoplication in patients with achalasia.
abstract: OBJECTIVE
  Analysis of outcome after laparoscopic myotomy for achalasia.
  
  
  METHODS
  Prospective audit.
  
  
  METHODS
  Teaching hospital, Sweden.
  
  
  METHODS
  All patients with achalasia who had a laparoscopic myotomy without a simultaneous fundoplication.
  
  
  METHODS
  Questionnaire, pH-measurements, radiography and manometry.
  
  
  METHODS
  Operative and postoperative complications and reoperations.
  
  
  RESULTS
  Twenty-one patients were scheduled for laparoscopic myotomy. Three were converted to open operations, and four were reoperated on transabdominally for persistent or recurrent symptoms. All patients were satisfied afterwards. Follow-up in 14 patients, after a median of 22 months (range, 6-40), included manometry, questionnaire, and 24-hour pH measurements, and showed significant reduction in the lower oesophageal sphincter pressure together with relief of symptoms. Three patients had reflux symptoms and abnormal pH readings. An additional five patients had abnormal pH measurements but no symptoms of reflux.
  
  
  CONCLUSIONS
  Heller myotomy can safely be done laparoscopically. Whether a simultaneous antireflux procedure is needed remains to be seen.
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden.
authors.forename: A P
authors.initials: AP
authors.lastname: Kjellin
authors.forename: S
authors.initials: S
authors.lastname: Granqvist
authors.forename: S
authors.initials: S
authors.lastname: Ramel
authors.forename: K B
authors.initials: KB
authors.lastname: Thor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery; D005260:Female; D018662:Fundoplication; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies