Holzman M D, Sharp K W, Ladipo J K, Eller R F, Holcomb G W, Richards W O
Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am J Surg. 1997 Apr;173(4):308-11. doi: 10.1016/S0002-9610(96)00398-4.
The authors have performed 11 myotomies in 10 patients (aged 12 to 77) with achalasia using minimally invasive techniques.
The initial 3 patients were treated via transthoracic approach; the subsequent 7 patients via transabdominal approach. The length of the myotomy was determined in conjunction with intraoperative endoscopy to facilitate dissection and demonstrate division of the lower esophageal sphincter.
Only 1 patient required intravenous and intramuscular narcotics more than 24 hours postoperatively; 2 patients required no postoperative narcotics. The average hospital stay for those patients successfully treated endoscopically averaged 2.0 +/- 0.5 days (range 1.5 to 3). One patient was converted to open thoracotomy secondary to perforation of the mucosa. One patient required repeat laparoscopic myotomy at 3 months due to recurrent dysphagia. Follow-up conducted at clinic visits showed all patients to have benefitted with relief of dysphagia; 80% (8) reported excellent results, 10% (1) reported good results, and 10% (1) fair results.
We converted from thoracic to laparoscopic myotomy because the abdominal approach simplified anesthetic and surgical management. We conclude that laparoscopic myotomy is a simple and effective treatment of achalasia.
