LAPAROSCOPIC CARDIOMYOTOMY WITH A DOR PATCH FOR ACHALASIA

OBJECTIVE: To evaluate early experience with laparoscopic Heller's car diomyotomy with placement of a Dor patch for achalasia. DESIGN: A pros pective case series. SETTING: A university teaching hospital. PATIENTS : Fourteen patients (5 men, 9 women, median age 47 years) with esophag eal achalasia, treated between July 1992 and July 1994. INTERVENTIONS: Laparoscopic Heller's cardiomyotomy with a Dor patch. MAIN OUTCOME ME ASURES: Clinical relief of symptoms, confirmed by esophageal manometry , 24-hour ambulatory pH monitoring and barium-contrast radiography. RE SULTS: Three of the 14 patients required conversion to an open procedu re, and 1 underwent early laparotomy for postoperative bleeding. The m edian operating time was 120 minutes (range from 75 to 210 minutes), a nd the median duration of hospitalization was 4 days (range from 3 to 18 days). Normal physical activity was resumed after a median of 2 wee ks (range from 0.5 to 6 weeks). Symptomatic dysphagia was completely r elieved in 12 patients and improved in 2. Only one patient experienced symptoms of reflux postoperatively. Postoperative esophageal manometr y (seven patients), 24-hour pH monitoring (five patients) and barium-m eal radiography (seven patients) confirmed the clinical results. CONCL USION: Laparoscopic Heller's cardiomyotomy with a Dor patch provides a viable alternative to open cardiomyotomy and forceful endoscopic dila tation.