Laparoscopic Heller myotomy for achalasia

Background: Laparoscopic Heller myotomy provides similar results to open He ller myotomy for the treatment of oesophageal achalasia with the advantage of quicker recovery. The present series examines the evolution of operative technique, postoperative outcome and the effect of the 'learning curve' in a group of 70 consecutive patients. Methods: Between 1992 and 1999. details of all patients undergoing oesophag ogastric myotomy for achalasia were prospectively entered on a database. Pa tients were followed with a biannual postal symptom questionnaire and score s were obtained for dysphagia, heartburn, regurgitation and chest pain. Com parison between preoperative and postoperative symptom scores, and case num ber and operative complications was made using Fisher's exact test or Mann- Whitney U-test where appropriate. Results: The indication for surgery was as a primary procedure in 20 cases; after failed endoscopic treatment in 48 cases; and after a 'failed' fundop lication in two cases. Myotomy was combined with a 360 degrees fundoplicati on in 57 patients and with an anterior fundoplication in 13 patients. Mucos al perforation occurred intraoperatively in 11 cases. Conversion to an open procedure was required in seven patients. Seven patients required a second operation. At a mean follow up of 2.9 years, symptom scores were significa ntly improved from preoperative values for dysphagia, regurgitation and che st pain (P < 0.001). There was no increase in the postoperative score for h eartburn. The 'learning curve' contributed significantly to the length of t he procedure, and the need for reoperation. Conclusions: Laparoscopic Heller myotomy is a technically challenging proce dure that provides good early palliation of the symptoms associated with ac halasia.