Surgical experience in treatment of achalasia cardia with minimal invasive surgery

Ali Yassin ,Falih Mohsen Al-Gazgooz ,Mazin H Al-Hawaz

doi:10.33762/mjbu.2019.163354

Abstract

Background: achalasia cardia is a motor disorder that result from absence of esophageal peristalsis combined with loss of relaxation of lower esophageal sphincter. Aims: To analyze the safety of laparoscopic Heller's myotomy with particular regard to the technical difficulties encountered, complications, the learning curve and outcome.Patients and methods: This study was done at Al - Sader Teaching Hospital, Basrah - Iraq in the period from February 2013 to June 2016. Thirty-two patients were included in the study of both gender and of different ages who were subjected to laparoscopic Heller's myotomy for achlasia cardia. They were observed regarding the development of operative and early post-operative complications, improvement of their symptoms, development of late post-operative complications and recurrence rate. Results: All patients underwent laparoscopic Heller's myotomy with Dor fundoplication except one patient had Toupet fundoplication. The mean operative time was 87 minutes and the median hospital stay was four days. Intra- operative complications include mucosal perforation in 3 patients, vagus nerve injury in 3 patients, and pleural perforation in 2 patients. Post-operative complications include atelectasis in 3 patients, pneumonia in 1 patient, GERD in 1 patient, post-operative leak in one patient and mortality in one patient. All patients improved regarding dysphagia (100%) and weight gain achieved in (91.3%), chest pain improved in (59%) and regurgitation improved in (84.6%) of the patients.Conclusion: Laparoscopic Heller's myotomy is safe and effective method for treatment of achalasia cardia.

Highlights

Achalasia cardia is a primary motor disorder that is characterized by loss of peristalsis of the esophageal body and absence relaxation of the lower esophageal sphincter. [1] It is manifested by dysphagia, regurgitation, retrosternal chest pain and weight loss. [2] It is a rare condition affecting 1 in 100,000 individuals, there are neither racial nor gender differences in its incidence according to epidemiological studies.[3]
This study aims to analyze the safety of laparoscopic Heller's myotomy with particular regard to the technical difficulties encountered, complications, the learning curve and outcome
PATIENTS AND METHODS This is a retro and prospective study was done on 32 patients diagnosed with acahalasia cardia who were subjected to laparoscopic Heller's myotomy with Dor or Toupet fundiplication at Al Sader Teaching Hospital Basrah - Iraq in the period from February 2013 to June 2016 with a follow up period for two years, among them 18 patients were females (56.25%) and 14 patients were males (43.75%) with a median age was (34.5) years range from (8-61) years

Summary

INTRODUCTION

Achalasia cardia is a primary motor disorder that is characterized by loss of peristalsis of the esophageal body and absence relaxation of the lower esophageal sphincter. [1] It is manifested by dysphagia, regurgitation, retrosternal chest pain and weight loss. [2] It is a rare condition affecting 1 in 100,000 individuals, there are neither racial nor gender differences in its incidence according to epidemiological studies.[3]. [4] Many studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy by laparoscopic Heller's myotomy because of its simplicity and superior outcome.[4,5] Many questions have been raised over the past decade regarding outcome after laparoscopic Heller's myotomy, including the long term relive of dysphagia, the frequency and severity of gastro-esophageal reflux, the rate of success and failure, and the need of reintervention and revision after myotomy.[5,6] This study aims to analyze the safety of laparoscopic Heller's myotomy with particular regard to the technical difficulties encountered, complications, the learning curve and outcome This is a retro and prospective study was done on 32 patients diagnosed with acahalasia cardia who were subjected to laparoscopic Heller's myotomy with Dor or Toupet fundiplication at Al Sader Teaching Hospital Basrah - Iraq in the period from February 2013 to June 2016 with a follow up period for two years, among them 18 patients were females (56.25%) and 14 patients were males (43.75%) with a median age was (34.5) years range from (8-61) years.

RESULT

Findings

DISCUSSION