title: Minimally invasive management of achalasia cardia: results from a single center study.
abstract: BACKGROUND
  Since the performance of the first laparoscopic cardiomyotomy for achalasia cardia in 1991, the popularity of the minimally invasive approach for this troublesome disease has been growing. We present our experience of 226 patients who underwent laparoscopic cardiomyotomy and discuss the relevant issues.
  
  
  METHODS
  A retrospective analysis was carried out of 226 patients who have undergone laparoscopic cardiomyotomy since 1993. The preoperative workup, surgical technique, and postoperative management are described.
  
  
  RESULTS
  Patients included 146 males and 80 females; average age was 36.4 years (range, 6 to 85). Mean duration of symptoms was 1.4 years. Nearly half of the patients (112) had undergone prior pneumatic dilatation. In 20 patients, myotomy alone was done, 44 patients had a Dor's fundoplication, and 162 had Toupet's fundoplication. The average operating time was 96 minutes. Mean postoperative hospital stay was 2.2 days. Dysphagia was eliminated in 88.9% of the patients with an overall morbidity of 4.4% and nil mortality over a mean follow-up of 4.3 years.
  
  
  CONCLUSIONS
  Laparoscopic cardiomyotomy with Toupet's fundoplication is a safe and effective treatment of achalasia cardia. Dor's fundoplication is done selectively, especially when suspicion is present of mucosal injury.
authors.affiliation: Department of GI & Minimal Access Surgery, Gem Hospital, Pankaja Mill Road, Ramanathapuram, Coimbatore-641045, Tamilnadu, India.
authors.forename: C
authors.initials: C
authors.lastname: Palanivelu
authors.forename: G S
authors.initials: GS
authors.lastname: Maheshkumar
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Jani
authors.forename: R
authors.initials: R
authors.lastname: Parthasarthi
authors.forename: K
authors.initials: K
authors.lastname: Sendhilkumar
authors.forename: M
authors.initials: M
authors.lastname: Rangarajan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome