Surgical experience in treatment of achalasia cardia with minimal invasive surgery

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. Intraoperative 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.