Laparoscopic Treatment in Achalasia of the Cardia
B. Ursut, L. Alecu, A. Tulin, O. EnciuOriginal article, no. 5, 2014
Background: Achalasia, although a rare disease (an incidenceof 1 100 000 individuals each year) is one of the commoncauses of motor dysphagia and is characterized by loss ofperistalsis in the esophageal body and lack of relaxation ofthe lower esophageal sphincter.Aim: The aim of our study was to perform a clinical,therapeutic and evolution evaluation in patients diagnosed withachalasia and operated in our department between 1997 and2013.
Material and Methods: We performed a retrospective studyusing the clinical charts, operatory protocols, imagistic and video database of the 17 patients with achalasia operated inour department.
Results: We encountered an equal repartition in women andmen and a predominance of urban provenience. Ages werebetween 24 and 86 years (with an average age of 51). Therewere two cases of recurrent achalasia at 2, respectively 5years after the first operation. In all cases, Heller myotomywas used, with the addition of a Dor fundoplication in 12 cases and Toupet fundoplication in five cases, as an antirefluxprocedure. Mean operation time was 117.6 minutes.There were three iatrogenic perforations of the esophagealmucosa, all of them recognized and treated in the sameoperative time. No postoperative complications related tothe Heller-Dor Heller-Toupet procedure were encountered.The follow-up was between 3 and 72 months.
Conclusions: Laparoscopic approach in the treatment ofachalasia provides the advantages of minimally invasivesurgery, but also and very important, a good visualization ofthe abdominal esophagus and gastroesophageal junction.Heller esocardiomyotomy is usually associated with anantireflux procedure. A Dor fundoplication is generally used,although the Toupet fundoplication may also be used withthe same advantages. It is important to monitor thesepatients on a yearly basis, knowing the risk of dysplasia carcinoma in achalasia.
Material and Methods: We performed a retrospective studyusing the clinical charts, operatory protocols, imagistic and video database of the 17 patients with achalasia operated inour department.
Results: We encountered an equal repartition in women andmen and a predominance of urban provenience. Ages werebetween 24 and 86 years (with an average age of 51). Therewere two cases of recurrent achalasia at 2, respectively 5years after the first operation. In all cases, Heller myotomywas used, with the addition of a Dor fundoplication in 12 cases and Toupet fundoplication in five cases, as an antirefluxprocedure. Mean operation time was 117.6 minutes.There were three iatrogenic perforations of the esophagealmucosa, all of them recognized and treated in the sameoperative time. No postoperative complications related tothe Heller-Dor Heller-Toupet procedure were encountered.The follow-up was between 3 and 72 months.
Conclusions: Laparoscopic approach in the treatment ofachalasia provides the advantages of minimally invasivesurgery, but also and very important, a good visualization ofthe abdominal esophagus and gastroesophageal junction.Heller esocardiomyotomy is usually associated with anantireflux procedure. A Dor fundoplication is generally used,although the Toupet fundoplication may also be used withthe same advantages. It is important to monitor thesepatients on a yearly basis, knowing the risk of dysplasia carcinoma in achalasia.
