[Laparoscopic myotomy in achalasia cardia treatment: experience after 36 operations].
BACKGROUND
Laparoscopic Heller-Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006.


OBJECTIVE
The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller-Dor operations.


METHODS
This partly retrospective, partly prospective study presented our results after laparoscopic Heller-Dor operation (presentation of the treatment method). We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intra- and postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms.


RESULTS
Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%). The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6%) and was successfully solved by balloon dilatation.


CONCLUSIONS
Laparoscopic Heller-Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.
School of Medicine, University of Belgrade, Belgrade, Serbia; Center for Esophageal Surgery, First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia.  m.bjelovic@med.bg.ac.rs
Miloš
M
Bjelović
Bratislav
B
Špica
Dragan
D
Gunjić
Danko
D
Grujić
Ognjan
O
Skrobić
Tamara
T
Babič
Predrag
P
Peško
D004931:Esophageal Achalasia / Q000453:epidemiology / Q000601:surgery*; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires