Efficacy, safety and long-term follow-up of laparoscopic Heller’s myotomy with anterior fundoplication in Achalasia

• Autor(a) principal: Nogueira, Carlos
• Data de Publicação: 2009
• Outros Autores: Santos, Jorge Nunes, Marcos, Mário Sérgio, Matos, Eduarda
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spcir.com/index.php/spcir/article/view/206

The primary indication for esophagocardiomiotomy at our institution over the last 12 years has been failure of endoscopic balloon dilation with consequent persistence of dysphagia or intra-procedure viscus perforation. In 1996 we began using a laparoscopic approach for esophagocardiomiotomy, thereby offering our patients a minimally invasive alternative to endoscopic dilation. Materials and Methods: We reviewed the case histories of twenty-three patients who underwent laparoscopic esophagocardiomiotomy with anterior fundoplication between November 1996 and November 2005. Data collected specifically reflected symptoms of the disease, pre-operative work-up and number of prior dilations performed. Patients were asked to respond to a symptom scale that considered the most common presenting complaints of this disorder (dysphagia, regurgitation, chest pain and heartburn) both pre- and post-operatively. Results: Mean operative time was 111 minutes. Four per-operative complications occurred, two minor lacerations of the splenic capsule, one pneumothorax and one esophageal perforation. An additional patient developed a post-operative esophageal fistula that was managed non-operatively. In this series there were no fatalities or need for conversion to an open procedure. Mean follow-up was 54.9 ± 29 months. Statistical analyses applied to the symptom scale demonstrated that the p values were significant for all the clinical variables studied. Conclusion: Laparoscopic esophagocardiomiotomy with anterior fundoplication should be considered, in our opinion, the procedure of choice in the treatment of achalasia. Keywords: Achalasia – Esophagocardiomiotomy – Laparoscopy.