Laparoscopic Heller's cardiomyotomy for achalasia of the cardia in a pregnant patient.

Dear Editor, Laparoscopy was first used for the evaluation of acute abdominal pain in pregnancy by gynaecologists in 1980.1 The most commonly reported laparoscopic procedure during pregnancy is laparoscopic cholecystectomy.2 Achalasia of the cardia is an oesophageal motor disorder, whose incidence in pregnancy is not known. As far as we know, there has been no report of laparoscopic Heller’s cardiomyotomy performed on a pregnant patient. We report a case of achalasia cardia of a pregnant patient in her second trimester treated adequately and safely with laparoscopic Heller’s myotomy. The patient was a 24-year-old primigravida in her second trimester of pregnancy who presented to us in August 2003 with persistent dysphagia for liquids and solids, occasional vomiting, anaemia, anorexia and weight loss. Endoscopy showed the dilated proximal portion of the oesophagus and a narrowing of the distal oesophagus. Oral contrast study showed a smooth filling defect with “rat tail” deformity, confirming that it was a case of achalasia cardia. She had undergone balloon dilatation twice in the third gestational month but the symptoms recurred. She was then referred to our institution for definitive treatment, so we planned for a surgical intervention. The risk of general anaesthesia and problems associated with surgery were explained to the patient. After the conventional preoperative preparation, the patient was taken for surgery. The patient was placed in a reverse Trendelenburg position with the legs apart. The chief surgeon stood between the patient’s legs; the camera surgeon and the first assistant stood at the right of the patient; the second assistant and the scrub nurse stood to the left of the patient. Pneumoperitoneum was created using the Hasson technique. A 10-mm optic port was placed 3 cm above the umbilicus; a 10-mm right working hand port was placed along the left Laparoscopic Heller’s Cardiomyotomy for Achalasia of the Cardia in a Pregnant Patient