Laparoscopic Heller Cardiomyotomy in the Visceral Surgery Department: About 5 Cases at the Hassan II University Hospital of Fez

Abstract

Achalasia is a primitive motor disorder of the esophagus characterized́ by a defect in relaxation of the lower esophageal sphincter (LES) and a complete absence of esophageal peristalsis. The etiology of this pathology is unknown. Clinical presentation is dominated by dysphagia, often associated with food regurgitation, more rarely with chest pain. Pyrosis may also be present. Symptoms have usually been evolving for many years, progressively worsening, and may be responsible for significant weight loss. Weight loss of more than 10kg, recent onset of symptoms (less than a year), and age over 60 should prompt a search for underlying neoplasia (pseudo-neoplastic achalasia). The diagnosis of achalasia was established on clinical, radiological and endoscopic grounds, in search of associated lesions. All patients underwent a Heller extra-mucosal oesocardiomyotomy associated with an anti-reflux device by cardioplasty. The post-operative course was straightforward in 4 cases, and complicated in 1 case by an iatrogenic breach of the esophageal mucosa, which was subsequently repaired. Functionally, dysphagia, regurgitation and retrosternal pain disappeared, with excellent results. The aim of this retrospective study was to investigate the im- mediate and remote results of surgical treatment of achalasia using the Heller technique.