Laparoscopic stapled cardioplasty for failed treatment of achalasia

Abstract

Treatment of primary achalasia includes injection of botulinum toxin, pneumatic dilatation or surgical myotomy. All of these procedures have an associated failure rate. Laparoscopic stapled cardioplasty (LSC) may be an alternative to failed pneumatic dilatation and laparoscopic Heller's myotomy where oesophagectomy has previously been the only surgical option. Selected patients with recurrent achalasia following multiple failed medical treatments, including myotomies, were managed by LSC. Patients had postoperative contrast swallows before discharge with clinical follow-up. All seven patients treated with LSC were discharged within 5 days. Rapid oesophageal emptying was noted on all post-LSC contrast swallows. No patient had an anastomotic leak. After 1 year, all but one patient was free from dysphagia, all had gained weight, and four patients had heartburn controlled by a proton pump inhibitor. LSC may be a useful procedure for resistant achalasia.