Symptomatic Outcome of Laparoscopic Cardiomyotomy Without an Antireflux Procedure

Abstract

The aim of surgical treatment in achalasia cardia is symptom relief. Most studies have evaluated the results of laparoscopic cardiomyotomy with an antireflux procedure. However, data on the effectiveness of laparoscopic cardiomyotomy without an antireflux procedure is sparse. We describe our experience of laparoscopic cardiomyotomy without antireflux procedure in 40 consecutive patients with respect to symptom relief and complications. There was no mortality and 1 conversion. Preoperatively dysphagia, regurgitation, and heartburn were present in 40, 39, and 11 patients. At a mean follow-up of 26 months, there was a significant improvement in symptom scores. Two patients (5%) had persistent postoperative dysphagia. One improved on conservative therapy, whereas other was treated with relaparoscopic cardiomyotomy. Three patients (7.5%) developed heartburn in the postoperative period, which was well controlled with proton pump inhibitors. Laparoscopic cardiomyotomy without antireflux procedure results in excellent relief of dysphagia without producing significant symptomatic reflux in the follow-up.

Recurrent achalasia treated with Heller myotomy: A review of the literature

“…The severity of symptoms was evaluated by a modified symptom score [17] , which consisted of the sum of the scores for dysphagia, regurgitation and chest pain. Recurrent achalasia is defined as recurrence of severe symptoms of dysphagia, regurgitation or chest pain (symptom scores of 2 or 3), and the need for intervention again, or repeat HM [18][19][20][21][22] . Data regarding the first author, year of publication, first-line treatment, operation duration, median hospital stay, and symptoms remission rate, were extracted.…”

Laparoscopic Heller’s Myotomy for Achalasia Cardia: One-Time Treatment in Developing Countries?

“…Most of the evidence for the management of achalasia has come from western countries, and relatively few data is from developing countries [11,[13][14][15][16][17][18]. Which modality suits patients in developing countries where majority of the population lives in rural with poor access to health care?…”

Laparoscopic Heller's cardiomyotomy: a viable treatment option for sigmoid oesophagus

“…Preoperative and postoperative oesophageal symptoms of achalasia were graded according to the following scorings systems: dysphagia was graded on a 5-point symptom-scoring scale from 0 to 4 of a modified Mellow-Pinkas scale, and regurgitation and heartburn were graded on a 4-point symptom scoring system of DeMeester, as described in our previous article [6]. Diseasespecific health-related quality of life (QOL) was assessed for achalasia [7].…”

“…Rapid-sequence anaesthesia was used to minimize the risks of aspiration; thereafter a five-port access was established and the patient was placed in a low lithotomy and reverse Trendelenburg position. Our standard technique of LCM as described earlier includes a five-port approach with limited mobilization of the oesophagus to expose its anterior surface without disturbing the posterior attachments, identification and preservation of the anterior vagus, clearance of fat pad at the GEJ, and the cardiomyotomy extended 4-6 cm on the oesophagus and approximately 2 cm on the stomach across the GEJ [6]. We do not routinely mobilize short gastric vessels unless a Dor fundoplication is planned.…”