THE OUTCOME OF LAPAROSCOPIC HELLER MYOTOMY WITHOUT ANTIREFLUX PROCEDURE IN PATIENTS WITH ACHALASIA

We retrospectively reviewed 30 patients with achalasia (18 males, 12 f emales) undergoing laparoscopic Heller myotomy without antireflux proc edure to determine relief of dysphagia and prevalence of postoperative gastroesophageal reflux. Preoperative symptoms were obtained by histo ry alone before 1996 and by standardized questionnaire after September 1996. Twenty-nine patients (97%) had dysphagia, 22 patients (23%) had regurgitation, 21 patients (70%) had weight loss, 7 patients (23%) ha d heartburn, and 4 patients (13%) had nocturnal aspiration. The first 3 patients were done thoracoscopically, with the,subsequent 27 patient s performed laparoscopically; 4 cases (13%; 1 thoracoscopic and 3 lapa roscopic), were converted. The mean postoperative stay was 1.9 days (1 -6 days). One patient underwent repeat laparoscopic myotomy for persis tent dysphagia. Twenty-eight patients (93%) were available for follow- up. Patients were asked on a standardized questionnaire to grade their relief of dysphagia, regurgitation, and heartburn. Good to excellent relief of dysphagia was obtained in 25 patients (89%), whereas 3 patie nts (11%) continued to have significant dysphagia postoperatively. Twe nty-four patients (86%) had little or no regurgitation. Four patients (14%) had frequent regurgitation. Twenty-four patients (89%) reported little or no heartburn. Three patients (11%) reported significant post operative heartburn. Laparoscopic Heller esophagomyotomy without antir eflux procedure provides excellent symptomatic relief of dysphagia in patients with achalasia. Early follow-up suggests that minimal occurre nce of symptomatic postoperative reflux can be achieved without perfor ming an antireflux procedure.