Laparoscopic treatment of esophageal achalasia.

An observational cohort study evaluated the initial results of using laparoscopic-approach cardioesophageal myotomy with Dor-type anterior fundoplicature for esophageal achalasia. The study involved our first 12 patients: five men and seven women whose median age was 51 years. Esophageal motility was vigorous in four patients; the other eight had aperistalsis. Conversion to laparotomy was required in one case. No postoperative mortality occurred. Postoperative complications included one left subdiaphragmatic abscess secondary to perforation of the esophageal mucosa, which was sutured. Median postoperative hospital stay was 5 days (confidence interval, 4.7-6.7 days). Symptom relief (disappearance of dysphagia) was recorded in 10 cases; relief with partial persistence of dysphagia was observed in the remaining two patients, who were treated by postoperative dilatation. As to the postoperative manometric results, the median basal pressure of the lower esophageal sphincter was reduced from 26.3 mm Hg preoperatively to 15.5 mm Hg postoperatively, with a tendency toward statistical significance (p = 0.08); the median esophageal isotopic retention after 15 min decreased from 60% preoperatively to 24.5% after surgery, with a tendency toward statistical significance (p = 0.07). Cardiomyotomy with Dor fundoplicature through a laparoscopic approach seems effective in treating esophageal achalasia.