English

Abstract

BACKGROUND: Achalasia cardia is characterized by a peristalsis in the body of the esophagus coupled with inadequate relaxation of the lower esophageal sphincter, leading to the development of progressive dysphagia. Surgical treatment in the form of laparoscopic Heller's cardiomyotomy with the addition of partial fundoplication procedure like anterior Dor fundoplication is being preferred as the treatment of choice for this condition. METHODS: A retrospective case record analysis of the patients with achalasia cardia who underwent treatment in our department was performed. We found 22 cases from January 2008 to August 2013. All patients were preoperatively subjected to barium swallow examination, upper gastrointestinal endoscopy and esophageal manometry. 21 patients had undergone surgical treatment and formed the study population while one patient underwent pneumatic dilatation. The patients were followed up to a maximum period of 14 months. RESULTS: There were 10 male and 11 female patients in our study with age range between 19 years and 75 years (mean 35.14±14.80). Dysphagia was the main presenting symptom (100%) followed by regurgitation of food, heartburn and chest pain. Seven patients (33.3%) had been subjected to laparoscopic Heller's myotomy while the rest (66.7%) underwent laparoscopic Heller's with anterior partial Dor fundoplication. There was one intraoperative small mucosal perforation which was repaired. Postoperatively all the patients had good relief from dysphagia. Two minor complications included development of gastroesophageal reflux symptoms and stickiness in the throat in one cases each. CONCLUSION: Laparoscopic myotomy is effective choice for the treatment of achalasia cardia. The use of Dor fundoplication helps to reduce symptomatic gastroesophageal reflux. Standard workup preoperatively should include barium swallow fluoroscopic examination, UGI endoscopy and esophageal manometry. Use of intraoperative endoscopy does not significantly enhance the operative times.