LAPAROSCOPIC CARDIOMYOTOMY FOR ACHALASIA

Surgical therapy of choice for achalasia is cardiomyotomy. Alternative procedure is the endoscopic pneumatic dilatation. Compared with the c onventional operation, the laparoscopic approach promised to have adva ntages concerning postoperative convalescence. Between May 94 and Octo ber 95 four patients with achalasia underwent a laparoscopic cardiomyo tomy. In all patients endoscopic therapy was tried. With the minimal i nvasive approach a myotomy of the esophagus was only shortly extended on the stomach. All patients had an endoscopic control of extension of the myotomy and intact mucosa during the operation. An antireflux pro cedure was not performed. Operation time came to 60 to 130 minutes. Al l patients immediately could swallow without problems and were dischar ged between day 2 and 8 postoperatively. During the follow-up (up to 1 8 months) all patients were free of dysphagia and regurgitation. The d ynamic x-ray of the esophagus showed a free passage into the stomach. Only one patient claimed mild symptoms of reflux. Cardiomyotomy can ve ry well be performed laparoscopically, leads to good functional result s and shows the expected advantages for patients concerning postoperat ive convalescence. The need for an antireflux procedure is discussed c ontroversely in the literature. It might be unnecessary if the myotomy is only shortly extended to the stomach.