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2003, Number 4

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Rev Mex Cir Endoscop 2003; 4 (4)

Current state of the minimal invasive surgery in treating achalasia

Zundel N, Chousleb E, Arias F, Roversi MA, Szomstein S, Higa G, Soto F, Podkameni D, Menzo E, Kennedy C, Rosenthal R

Language: Spanish
References: 34
Page: 173-177
PDF size: 52.64 Kb.


ABSTRACT

With the arrival of minimal invasive surgery, the laparoscopic technique in treating achalasia has become the golden standard. We present a series of cases from 142 patients treated by Heller’s myotomy through laparoscopic and thoracoscopic way. We compare our results against those ones reported in literature. Method: From January 1992 to December 2003, it was carried out a multicenter and retrospective study on the 142 patients’ records treated by lest-invasion surgery in treating achalasia. The results were compared with the literature published both in English and Spanish. Results: One hundred and seventeen patients (83%) were treated by laparoscopy in order to perform Heller’s myotomy. Twenty-five patients (17%) were subjected to thoracoscopy. The follow-up of the patients took 11.5-year period and 8.2-year periods for the groups of laparoscopy and thoracoscopy respectively. The surgery time ranged from 70 to 190 minutes (mean: 100), all the processes being finished through the chosen surgery via. The manometric findings that were observed during the postoperative period, 32 ± 4 mmHg in the lower esophageal sphincter (LES), decreased to 13 ± 6 mmHg in the postoperative period. Eighteen patients presented (13%) complications during this series. The most common alteration was dysphagia, which occurred in 4 patients (3%) and perforation in other 4 patients (3%). This last complication was detected and treated during the same surgical intervention. The dysphagia case required a further treatment in every patient. Two of them required pneumatic distention, another case needed an incomplete myotomy, and other one through a very tight antireflux surgery. Four patients (3%) required to be reoperated, three ones from the laparoscopy group, and other one from the thoracoscopy group. There was no mortality in this series. Conclusion: The laparoscopic treatment is safe and efficient. It can be applied on every patient prospective to surgery. Our series results are alike the ones published by the world literature.


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