title: Minimally invasive surgery for achalasia: a 10-year experience.
abstract: Minimally invasive esophagomyotomy for achalasia has become the preferred surgical treatment; the employment of a concomitant fundoplication with the myotomy is controversial. Here we report a retrospective analysis of 53 patients with achalasia treated with laparoscopic Heller myotomy; fundoplication was used in all patients except one, and 48 of the fundoplications were complete (floppy Nissen). There were no deaths or reoperations, and minor complications occurred in three patients. Good-to-excellent long-term results were obtained in 92% of the subjects (median follow-up 3 years). Two cases (4%) of persistent postoperative dysphagia were documented, one of which was treated with dilatation. Postoperative reflux occurred in five patients, four of whom did not receive a complete fundoplication; these patients were well controlled with medical therapy. We suggest that esophageal achalasia may be successfully treated with laparoscopic Heller myotomy and floppy Nissen fundoplication with an acceptable rate of postoperative dysphagia.
authors.affiliation: Department of Surgery, Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA. cfrantzides@enh.org
authors.forename: Constantine T
authors.initials: CT
authors.lastname: Frantzides
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Moore
authors.forename: Mark A
authors.initials: MA
authors.lastname: Carlson
authors.forename: Atul K
authors.initials: AK
authors.lastname: Madan
authors.forename: John G
authors.initials: JG
authors.lastname: Zografakis
authors.forename: Ali
authors.initials: A
authors.lastname: Keshavarzian
authors.forename: Claire
authors.initials: C
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome