Laparoscopic management of idiopathic esophageal achalasia.

INTRODUCTION Idiopathic esophageal achalasia was described in 1682 as a motor disorder of smooth muscle. In 1913 transabdominal cardiomyotomy was introduced and in 1958 this technique was popularized via a left thoracotomy, in 1991 laparoscopic cardiomyotomy was introduced since then many surgeons have adopted this technique as the primary treatment of esophageal achalasia. OBJECTIVE Evaluate usefulness and recent advances in endoscopic surgery for the management of esophageal achalasia, as well as general issues in clinical presentation and diagnosis. METHODS We did a review of the medical literature and of our series of patients treated between 1996 and 2004. RESULTS Between 1996 and 2004, 84 patients underwent laparoscopic Heller myotomy and partial funduplication (78 Toupet and 6 Dor) for the treatment of achalasia. Operative time ranged from 2 to 3 hours with a mean of 2.5 hours. Mucosal perforation (esophageal/gastric) occurred in 3 patients and was repaired with primary closure. During follow-up 3 patients required postoperative endoscopic dilation and one required reoperation due to adhesions causing angulation of the g-e-junction. CONCLUSIONS Laparoscopic Heller myotomy provided marked reduction in dysphagia, with minimal complaints of regurgitation, heartburn and chest pain at a mean follow-up of 2 years.