LAPAROSCOPIC HELLERS CARDIOMYOTOMY AND DORS FUNDOPLICATION FOR ESOPHAGEAL ACHALASIA

The study's aim was to assess the functional results of laparoscopical ly performed Heller's myotomy and Dor's fundoplication in our first fe w cases of esophageal achalasia. Pour male patients (mean age: 61 year s) with long-standing symptoms of achalasia (documented on esophagogra m and esophageal manometry) and not responding to several sessions of pneumatic dilatation, had laparoscopic Heller's myotomy and Dor's fund oplication. Myotomy was facilitated by distending the esophagus. The m ean duration of the operation was 99 min. The third patient developed a leak from the exposed esophageal mucosa on the 5th postoperative day while at home. The leak was attributed to late desloughing of a mucos al burn, and was sealed spontaneously 15 days later after drainage. Th e remaining three patients were discharged after resuming diet within the first 2 postoperative days. By 1 year postoperatively, dysphagia w as abolished in all cases, and there were no gastroesophageal reflux s ymptoms. The esophagogram showed no reflux, which was also confirmed o n ambulatory 24-h esophageal pH measurement. On manometry, lower esoph ageal sphincter (LES) pressure dropped significantly postoperatively ( preop: 56 +/- 7 SD mm Hg, postop: 5 +/- 1 SD mm Hg, p < 0.001). In con clusion, laparoscopic Heller's myotomy with Dor's fundoplication for e sophageal achalasia is a feasible procedure, offering clinical and lab oratory results similar to the open approach, but with better patient tolerance.