LAPAROSCOPIC SURGICAL-TREATMENT OF ACHALASIA

BACKGROUND: The authors have performed 11 myotomies in 10 patients (ag ed 12 to 77) with achalasia using minimally invasive techniques. METHO DS: The initial 3 patients were treated via transthoracic approach; th e subsequent 7 patients via transabdominal approach, The length of the myotomy was determined in conjunction with intraoperative endoscopy t o facilitate dissection and demonstrate division of the lower esophage al sphincter. RESULTS: Only 1 patient required intravenous and intramu scular narcotics more than 24 hours postoperatively; 2 patients requir ed no postoperative narcotics. The average hospital stay for those pat ients successfully treated endoscopically averaged 2.0 +/- 0.5 days (r ange 1.5 to 3). One patient was converted to open thoracotomy secondar y to perforation of the mucosa. One patient required repeat laparoscop ic myotomy at 3 months due to recurrent dysphagia. Follow-up conducted at clinic visits showed all patients to have benefitted with relief o f dysphagia; 80% (8) reported excellent results, 10% (1) reported good results, and 10% (1) fair results. CONCLUSION: We converted from thor acic to laparoscopic myotomy because the abdominal approach simplified anesthetic and surgical management. We conclude that laparoscopic myo tomy is a simple and effective treatment of achalasia. (C) 1991 by Exc erpta Medica, Inc.