Laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia

Background: Although surgical myotomy is considered the gold standard, many different treatments have been advocated for achalasia. There are now a nu mber of reports of cardiomyotomy being performed laparoscopically. Methods: This is a prospective study of 82 patients (47 male and 35 female; median age, 47 years) who underwent laparoscopic cardiomyotomy and anterio r partial fundoplication for achalasia. Results: Four of the 82 procedures required conversion to open surgery, all during the early stages of the series, and two required early reoperation for a postoperative problem. The median operating time was 80 min (range, 3 2-210). the median hospital stay was 3 days (range, 2-18), and normal physi cal activity was resumed after a median of 2 weeks (range, 3 days to 12 wee ks). Follow-up ranged up to 8 years (median, 2). Postoperatively, symptoms of dysphagia (to both solids and liquids), heartburn, odynophagia, chest pa in, regurgitation, and cough were significantly reduced in all patients. Th e median overall satisfaction score (graded from 0 to 10, with 10 represent ing total satisfaction) was 9 (range, 0-10), and 90% of patients were highl y satisfied with the surgical outcome. Conclusion: Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity.