title: Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique.
abstract: BACKGROUND
  Several surgical methods have been described to treat achalasia with a recent trend toward utilizing minimally invasive techniques to perform a myotomy. Since 1998 our institution has utilized a minimally invasive thoracoscopy-assisted technique (ThAM) that allows a myotomy to be performed under direct visualization.
  
  
  METHODS
  From 1992 to 2002, 57 patients underwent transthoracic Heller myotomy at our institution. Thirty-eight patients (67%) who underwent ThAM were reviewed and compared with 19 (33%) who previously underwent myotomy through a standard open left thoracotomy (OM).
  
  
  RESULTS
  There were no operative deaths in the ThAM group (n = 38) and 4 patients (11%) experienced minor morbidity. Four ThAM patients required conversion to open thoracotomy and 2 were lost to follow-up. Of the remaining 32 patients, 29 have improved postoperative dysphagia scores after a mean follow-up of 17 months. Only 4 patients have required further endoscopic or surgical intervention. Compared with the OM group, ThAM patients experienced significantly shorter average surgery time (97 versus 139 minutes), less blood loss (80 versus 155 mL), less postoperative narcotic requirement (8 versus 20 days), and shorter recovery to normal activity (20 versus 73 days).
  
  
  CONCLUSIONS
  Thoracoscopy-assisted myotomy results in excellent relief of dysphagia in the short term and would be expected to have long-term results similar to OM. Shorter operating and recovery times as compared with OM without the need for an antireflux procedure makes ThAM an attractive minimally invasive technique.
authors.affiliation: Department of Surgery, Thoracic Division, Indiana University School of Medicine, Indianapolis, Indiana, USA. kkesler@iupui.edu
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kesler
authors.forename: Stacey E
authors.initials: SE
authors.lastname: Tarvin
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Brooks
authors.forename: Karen M
authors.initials: KM
authors.lastname: Rieger
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009130:Muscle, Smooth / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*