Laparoscopic Heller myotomy improves esophageal emptying and the symptoms of achalasia

Hypothesise Laparoscopic Heller esophageal myotomy improves esophageal clea rance and symptoms of achalasia in the early and late postoperative periods . Design: We followed up 98 consecutive patients attending a referral center between February 1, 1994, and July 1, 2000, who underwent laparoscopic myot omy. Operative time, complications, and length of star were recorded. Posto perative outcomes were assessed using Van Trappen symptom scores (1 indicat es no symptoms; 2, symptoms occurring less than once a week; 3, symptoms oc curring more than once weekly; and 4, persistent symptoms) and scintigraphi c esophageal transit studies. Results: Of 98 patients, 91 underwent anterior fundoplication. There were n o open conversions and 1 mucosal perforation, which was closed laparoscopic ally without complications. Mean operative times and postoperative days wer e 3.2 hours and 4.3 days, respectively, in the first 32 patients and 1.7 ho ur, and 2.3 days, respectively, in the last 32 patients (P<.001). Postopera tive complications included pneumothorax (4% of patients), atelectasis (5%) , and delayed gastric emptying (1%). Seventy-five percent of patients gaine d weight after surgery. At longest followup, 91% of patients were satisfied with the outcome of the procedure. Mean Van Trappen scores fur dysphagia i mproved from 4.0 in the preoperative period to 1.2 at early and late follow -up (P<.001). Fluid retention at 10 minutes in the upright position was 47% in the preoperative period and improved at early and late follow-up to 21% and 20%, respectively (P<.001). Conclusions: Laparoscopic Heller myotomy can safely reverse the symptoms of achalasia and improve esophageal transit. These benefits, realized during the early postoperative period, were maintained at longest follow-up.