Laparoscopic cardiomyotomy for achalasia

Surgical therapy of choice for achalasia is cardiomyotomy. Alternative procedure is the endoscopic pneumatic dilatation. Compared with the conventional operation, the laparoscopic approach promised to have advantages concerning postoperative convalescence. Between May 94 and October 95 four patients with achalasia underwent a laparoscopic cardiomyotomy. In all patients endoscopic therapy was tried. With the minimal invasive approach a myotomy of the esophagus was only shortly extended on the stomach. All patients had an endoscopic control of extension of the myotomy and intact mucosa during the operation. An antireflux procedure was not performed. Operation time came to 60 to 130 minutes. All patients immediately could swallow without problems and were discharged between day 2 and 8 postoperatively. During the follow-up (up to 18 months) all patients were free of dysphagia and regurgitation. The dynamic x-ray of the esophagus showed a free passage into the stomach. Only one patient claimed mild symptoms of reflux. Cardiomyotomy can very well be performed laparoscopically, leads to good functional results and shows the expected advantages for patients concerning postoperative convalescence. The need for an antireflux procedure is discussed controversely in the literature. It might be unnecessary if the myotomy is only shortly extended to the stomach.