Introduction: Surgical myotomy is an affective alternative to medical or endoscopic treatment of achalasia, especially in young patients or those suffering recurrence after dilatation. The technical characteristics of extra-mucosal Heller myotomy (a functional intervention in an anatomical area easily accessible by laparoscopy) has modified the surgical approach and has been proposed as a good indication for the laparoscopic approach. However, no comparative studies have been performed on the efficacy of each type of approach. Aim: To compare the immediate- and medium-term results of surgical treatment of achalasia with open and laparoscopic surgery. Material and methods: The immediate-and mediumterm results in a series of 31 patients who underwent surgery between 1990 and 2000 were reviewed. Diagnosis was based on clinical, endoscopic and mano metric findings. Pre- and postsurgical symptomatology was evaluated through a score (modified DeMeester: dysphagia, pyrosis, pain and regurgitation on a scale of 0-3) as well as through conversion rate, immediate- and medium-term morbidity and mortality, hospital stay, and degree of satisfaction with the operation (scale 0-4). Results: Thirteen patients underwent open surgery (group I) and 18 underwent laparoscopic surgery (group II). In all patients Heller myotomy was performed. Anterior Dor hemifundoplication was also performed in 29 patients and posterior Toupet hemifundoplication was performed in two. One patient required conversion to open surgery and in another a pneumoperitoneum could not be created due to adhesions from previous surgery. One patient who had previously undergone open surgery suffered recurrence of achalasia and underwent laparoscopic reintervention. No differences were found in operating time (132 ± 29 min vs. 140 ± 25 min, p: ns) or in morbidity and mortality, although a significance reduction was found in postoperative stay (7.7 ± 2 vs. 3.7 ± 1 days, p < 0.0001) and resumption of normal activities (45 ± 20 vs. 20 ± 13 days, p < 0.002). Both techniques were equally effective is reducing achalasia symptomatology although the laparoscopic approach produced greater esthetic satisfaction (2.2 ± 1.1 vs. 3.4 ± 0.7 vs. p < 0.005). Conclusion: The laparoscopic approach shows the same characteristics as conventional surgical treatment but adds the advantages of a less aggressive technique.
|Publication status||Published - 1 Jan 2001|
- Heller's myotomy
- Laparoscopic surgery