[Heller's myotomy with fundoplication by endoscopic surgery].
BACKGROUND
We undertook this study to present a 5-year experience in laparoscopic treatment of achalasia using Heller myotomy with an antireflux technique.


METHODS
Fourteen patients with diagnosis of achalasia were included. We analyzed age, sex, symptoms, endoscopy, radiology and manometry results, pre- and postoperative treatment, fundoplication technique, surgical time and Visick Score.


RESULTS
Heller myotomy with an antireflux technique was carried out in 14 patients: Dor was performed in eight patients, Toupet in four patients, and Nissen in two patients. Average surgical time was 145 min, which decreased to 130 min in those patients who underwent Dor fundoplication. Oral feeding was started 1.5 days after surgery and the average hospital stay was 2.5 days. Visick Score was as follows: grade I-six patients (42.8%, Dor four patients, Toupet one patient, Nissen one patient); grade II-four patients (28.5%, Dor three patients, Toupet one patient); grade IIIA-two patients (14.2%, Dor two patient); grade IVA-one patient (7.1%, Toupet); grade IVB-one patient (7.1%, Nissen-Rossetti).


CONCLUSIONS
Heller myotomy is currently the gold standard in the treatment of achalasia and should be performed with an antireflux procedure. In our series, we have found that there are fewer complications with Dor fundoplication, the procedure is easier (implying shorter surgical time), and it offers the best results as compared with other antireflux techniques.
Servicio de Cirugía General y de Invación Minima, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, 07760 México, D.F., Mexico. javigar@avantel.net
Javier
J
García-Alvarez
Alfredo
A
Ruiz-Vega
Ulises
U
Rodríguez-Wong
José Luis
JL
Hernández-Reguero
D000293:Adolescent; D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D012189:Retrospective Studies