Laparoscopic Heller Myotomy for Achalasia: A Review of the Controversies

Division of Thoracic Surgery, Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York 10029-6574, USA.
The Annals of thoracic surgery (Impact Factor: 3.85). 03/2008; 85(2):S743-6. DOI: 10.1016/j.athoracsur.2007.12.004
Source: PubMed


Achalasia is a rare primary motility disorder of the esophagus with a United States prevalence of less than 0.001%. Laparoscopic modified Heller myotomy has become the standard of care for palliation of this incurable but benign disease. The role of a fundoplication with the myotomy continues to be controversial. This report summarizes the current laparoscopic management of achalasia with a review of the medical literature on the outcome of combining a fundoplication with a laparoscopic myotomy. The optimal length of myotomy as suggested in the literature is also summarized. To complete the goal, peer-reviewed publications were identified in PubMed by search terms achalasia, myotomy, fundoplication, Nissen, Dor, and Toupet.

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    • "The standard surgical treatment for achalasia is the Heller myotomy, although different techniques can be used. The advantages of surgical treatment include a significant reduction in symptoms, shortened hospital stay, low rate of postoperative complications, and low rate of gastrooesophageal reflux [12]. The advantages of minimally invasive procedures (less postoperative pain, early mobilization, etc.) are well known in modern surgical practice. "
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    ABSTRACT: Achalasia is a rare disorder characterised by obstruction of the distal oesophagus and subsequent dilation of the proximal oesophagus. Patients generally complain of gastrointestinal symptoms; however, pulmonary symptoms and complications may also occur. A 35-year-old woman was brought to our emergency service complaining of sudden-onset dyspnea that started 15 minutes earlier during dinner. She suffered a cardiopulmonary arrest due to aspiration 5 minutes after being admitted to the emergency room and was intubated. Thoracic computed tomography examination showed that her oesophagus was filled with undigested food. Heller cardiomyotomy and Dor fundoplication was performed via laparotomy with the diagnosis of primary achalasia, and she was discharged as uneventful on the 5th postoperative day.
    Full-text · Article · Dec 2012
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    ABSTRACT: A laparoscopic Heller-Dor operation is a safe and effective procedure for esophageal achalasia. We experienced postoperative gastric volvulus after performing a laparoscopic Heller-Dor operation. This was successfully treated with laparoscopic-assisted gastropexy. A 56-year-old Japanese woman had complained of dysphagia for 3 years. She was diagnosed as having achalasia and then underwent a laparoscopic Heller-Dor operation. She complained of nausea and abdominal fullness on postoperative day 5 and gastrography revealed organoaxial gastric volvulus. We performed a reoperation using a laparoscopic-assisted approach. Because of preexisting gastric ptosis, the stomach was unusually movable. In addition, a rotational torque due to the fundoplication might have caused the volvulus. We performed an anterior gastropexy. The patient’s dysphagia disappeared after the second surgery, and recurrent volvulus has not been observed for 13 months. In cases with an unusually movable stomach, the addition of gastropexy may be effective in preventing postoperative gastric volvulus, which is rare but may possibly occur after laparoscopic fundoplication.
    No preview · Article · Sep 2013 · Esophagus
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    ABSTRACT: This study reports the usefulness and safety of endoscope-guided pneumatic dilatation (PD) technique without using fluoroscopy. From January 1998 to June 2004, a total of 33 patients with achalasia, including 20 males and 13 females, received PD in our unit. The mean age was 48.5+/-17.5 years (range: [corrected] 18 to 93 y). All patients underwent endoscopic-guided PD by using a 3.0 cm [corrected] diameter "Regiflex" balloon dilator (Microvasive, Watertown, MA). The results of PD were recorded and evaluated by symptom scores based on the frequency of attack of 3 major symptoms: dysphagia, regurgitation, and chest pain, both before, and then 6 weeks, 6 months, 1 year after PD was performed. Thirty-three patients were treated, excellent results in 27, good results in 3, and failure in 3 (1 requiring surgical treatment later). Overall, we demonstrated that the technique is effective and safe option for achalasia treatment.
    Full-text · Article · Mar 2008 · Surgical laparoscopy, endoscopy & percutaneous techniques
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