The treatment of achalasia by laparoscopic Heller's cardiomyotomy may
combine the minimally invasive advantages of pneumatic dilatation with
the success rate and low risk of perforation of conventional surgery.
The requirement for an antireflux procedure remains a contentious iss
ue, as in conventional surgery. Nine patients underwent laparoscopic c
ardiomyotomy; excellent symptomatic relief was obtained in eight at fo
llow-up between 12 and 21 months after operation. Four of these patien
ts agreed to 24-h pH monitoring and showed no evidence of acid reflux.
One patient, however, developed recurrent symptoms associated with si
gnificant acidity on monitoring. Laparoscopic Heller's cardiomyotomy w
ithout an antireflux procedure produced effective symptomatic relief i
n this small group of patients.