Minimally invasive surgery for esophageal achalasia.
BACKGROUND
Esophageal achalasia is characterized by loss of peristaltic activity and failure of relaxation of the lower esophageal sphincter (LES). The characteristic dysphagia may be alleviated by surgery, dilations, or botulinum toxin injections. Video-endoscopic surgery is used increasingly.


METHODS
This paper reports our experience with 142 consecutive achalasia patients treated by laparoscopic Heller myotomy and Dor antireflux fundoplication and followed for a median 26 months.


RESULTS
Overall, the actuarial lifetable analysis showed a 90% probability of a patient's being symptom free over a 5-year period. Radiologic assessment showed a significant reduction in esophageal diameter and manometry a significant reduction in the resting tone and residual pressure of the LES. Twenty-four-hour pH monitoring showed postoperative reflux in 6.7% of patients. Persistent dysphagia or chest pain (i.e., failure of treatment) were reported by 15 patients (10.6%): 14 of them were subsequently treated with multiple pneumatic dilations, which were successful in 12 cases.


CONCLUSIONS
Laparoscopic Heller myotomy with Dor fundoplication is a feasible and effective treatment for achalasia, with an actuarial success rate of 90% at 5 years. With additional dilation, a 98% success rate can be achieved.
Zaninotto
G
G
Department of Medical and Surgical Sciences, Clinica Chirurgica IV, University of Padua, School of Medicine, Italy. giovanni.zaninotto@unipd.it
Costantini
M
M
Molena
D
D
Portale
G
G
Costantino
M
M
Nicoletti
L
L
Ancona
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D015993:Life Tables; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012189:Retrospective Studies