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2004, Number 1

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Rev Mex Cir Endoscop 2004; 5 (1)

Laparoscopic esophageal myotomy for treatment of achalasia. Experience in a mexican hospital

Moreno PM, Pereira-Graterol F, Alvarado-Aparicio HA, Rojano-Rodríguez M, Herrera-Esquivel J

Language: Spanish
References: 19
Page: 29-37
PDF size: 172.96 Kb.


ABSTRACT

Background: Many therapeutics options has been used for the achalasia treatment, nevertheless, the laparoscopic esophageal myotomy offers the best outcomes. Material and methods: Retrospective study of consecutive patients with achalasia subjected to laparoscopic esophageal myotomy between February 1993 and May 2003. We described the surgical technique and the outcomes. Results: Fifty-six surgical records were revised, 60.7% were females, with a median duration of symptoms: 56.7 months. We observed more surgical difficulties in patients with endoscopic therapies. A complete antirreflux surgical procedure (posterior esophageal-gastropexia) was done in most of the patients. We observed postoperative persistent dysphagia and regurgitation in 3.5% of the cases. The lower esophageal sphincter pressure was reduced 25.23 mmHg after the surgical myotomy and 24-hours esophageal pH-monitoring was keeping in normals parameters. Five mucosal perforations were diagnosed, four were repaired during the same surgical procedure without conversion to open technique and the surgical objective was obtained. One female patient was dead after an undiagnosed esophageal perforation. Conclusion: Laparoscopic esophageal myotomy is the more effective therapeutic option in the achalasia treatment and posterior esophageal-gastropexia is a secure antirreflux procedure.


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