Laparoscopic Esophageal Myotomy and Anterior Partial Fundoplication for the Treatment of Achalasia

• Published in: The Annals of thoracic surgery Vol. 64; no. 3; pp. 785 - 789
• Main Authors: Graham, Andrew J, Finley, Richard J, Worsley, Daniel F, Dong, Sunny R, Clifton, Joanne C, Storseth, Carol
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.09.1997
• Subjects: Adult; Aged; Deglutition Disorders - surgery; Esophageal Achalasia - surgery; Esophageal Perforation - etiology; Esophagus - injuries; Esophagus - surgery; Female; Follow-Up Studies; Fundoplication - adverse effects; Fundoplication - methods; Gastric Acid; Gastrointestinal Transit; Hospitalization; Humans; Hydrogen-Ion Concentration; Incidence; Intraoperative Complications; Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Male; Middle Aged; Muscle, Smooth - surgery; Patient Satisfaction; Pressure; Supine Position; Surveys and Questionnaires; Time Factors; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(97)00628-0

Background. The purpose of this study was to determine the initial results of laparoscopic esophageal myotomy and anterior fundoplication in the treatment of 26 patients with achalasia. Methods. Operative time, complications, and length of hospitalization were recorded for each patient. Postoperative outcomes were assessed by a standardized patient questionnaire, 24-hour esophageal pH studies, and esophageal transit studies. Results. Twenty-six consecutive patients with class IV dysphagia underwent a laparoscopic esophageal myotomy and anterior partial fundoplication, with a single incidence of intraoperative esophageal perforation. The mean operative time was 3.5 hours. The median length of hospitalization was 5 days. Of the 21 patients for whom follow-up was available (median follow-up, 4 months), 19 (90%) were satisfied and 2 (10%) were somewhat satisfied with their surgery. After operation, 14 of the 21 patients (67%) reported no dysphagia (class I), whereas 6 (28%) had class II dysphagia (less than once per week) and only 1 (5%) had class III dysphagia (greater than once per week). Liquid-phase esophageal transit studies (n = 14) revealed a significant improvement in esophageal clearance in the supine position from 18% before operation to 44% after operation ( p = 0.006). Distal esophageal acid exposure was normal in 6 of 7 patients. Conclusions. These early results suggest that laparoscopic esophageal myotomy and anterior partial fundoplication provides efficacious treatment of achalasia.