Laparoscopic esophagomyotomy for achalasia.
Results of an ongoing clinical study treating achalasia patients with a transabdominal laparoscopic Heller myotomy and Toupet partial fundoplication are presented. Twelve patients underwent surgery between January 1992 and October 1993. All patients had barium esophagograms, preoperative endoscopy, esophageal manometry, 24-h pH studies, and extensive GI history preoperatively. Surgical complications included two perforations of the mucosa at the gastroesophageal junction repaired laparoscopically. There were no surgical mortalities and the average hospital stay was 39 h. Postoperatively all patients at follow-up had a repeat GI history, esophagogastroscopy, 24-h pH testing, and esophageal manometry. This follow-up showed good-to-excellent relief of dysphagia in all 12 patients with one patient complaining of heartburn documented to be from reflux postoperatively. Manometry showed a mean decrease in the lower esophageal sphincter pressure from 33.4 mmHg preoperatively to 19.3 mmHg postoperatively; 24-hour pH testing showed no significant reflux in the nine patients who had Heller myotomy plus a Toupet fundoplication. However, two of three patients who had Heller myotomy alone demonstrated abnormal 24-h pH testing. One of these patients was symptomatic and was found to have mild esophagitis by biopsy on postoperative endoscopy. These good results have persisted for mean follow-up of 16 months.