title: Laparoscopic stapled cardioplasty for failed treatment of achalasia.
abstract: BACKGROUND
  Treatment of primary achalasia includes injection of botulinum toxin, pneumatic dilatation or surgical myotomy. All of these procedures have an associated failure rate. Laparoscopic stapled cardioplasty (LSC) may be an alternative to failed pneumatic dilatation and laparoscopic Heller's myotomy where oesophagectomy has previously been the only surgical option.
  
  
  METHODS
  Selected patients with recurrent achalasia following multiple failed medical treatments, including myotomies, were managed by LSC. Patients had postoperative contrast swallows before discharge with clinical follow-up.
  
  
  RESULTS
  All seven patients treated with LSC were discharged within 5 days. Rapid oesophageal emptying was noted on all post-LSC contrast swallows. No patient had an anastomotic leak. After 1 year, all but one patient was free from dysphagia, all had gained weight, and four patients had heartburn controlled by a proton pump inhibitor.
  
  
  CONCLUSIONS
  LSC may be a useful procedure for resistant achalasia.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal Berkshire Hospital, Reading, UK. Thomas.Dehn@royalberkshire.nhs.uk
authors.forename: T C B
authors.initials: TC
authors.lastname: Dehn
authors.forename: M
authors.initials: M
authors.lastname: Slater
authors.forename: N J
authors.initials: NJ
authors.lastname: Trudgill
authors.forename: P M
authors.initials: PM
authors.lastname: Safranek
authors.forename: M I
authors.initials: MI
authors.lastname: Booth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002299:Cardia / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D017792:Surgical Stapling / Q000379:methods*; D017211:Treatment Failure; D055815:Young Adult