THORACOSCOPIC ESOPHAGEAL MYOTOMY IN THE TREATMENT OF ACHALASIA

We treated 24 patients with achalasia using thoracoscopic (22 patients ) or laparoscopic (2 patients) esophagomyotomy. The only operative com plications were mucosal lacerations, which occurred in 3 patients and required conversion to an open procedure in 2. Twenty-two (91%) patien ts were eating by the second postoperative day. Analgesics were only r equired for the management of pain from the chest tube, which remained in place for a median time of 24 hours. The median postoperative hosp ital stay was 3 days (range, 20 to 14 days). The myotomy proved to be incomplete in the first 3 patients, who required a second myotomy; thi s was done laparoscopically in 2. One patient had a paraesophageal her nia repaired 6 months after the myotomy, and 1 patient required an eso phagectomy 1 year after the myotomy for a large nonfunctioning esophag us. Late follow-up showed that swallowing was excellent in 17 (71%) an d fair to good in 4 (17%). Sixteen (66%) of these 24 patients have reg ained their original weight. Thus, excellent to good results were ulti mately obtained in nearly 90% of the patients. These results suggest t hat esophageal myotomy performed using minimally invasive techniques a ears to be the treatment of choice for achalasia.