Laparoscopic Heller’s Myotomy for Achalasia Cardia by Blunt Dissection: a Safe Technique
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Laparoscopic Heller myotomy (LHM) is the “gold standard” surgical treatment for achalasia cardia (AC). Prevailing techniques of LHM have been associated with a high rate (2–33%) of esophageal perforation. The aim of this study is to describe a novel technique of LHM using blunt dissection and to present our initial experience. This study is a retrospective analysis of patients with AC who underwent LHM by a blunt dissection technique (BDT) by a single surgeon from 2011 to 2016. Out of total 35 patients, 22 were males (62.8%) and the mean age was 32 years. None of the patients had endoscopic dilatation and/or other therapeutic procedures before surgery. Median preoperative modified Takita dysphagia grade was 3. The mean lower esophageal sphincter (LES) pressure before surgery was 41.88 mm of Hg. The mean operative time was 72.8 min, and the mean blood loss was 34.5 ml. The median length of postoperative hospital stay was 3 days. No patient required conversion to open surgery and there were no intraoperative and postoperative complications. All patients had sustained symptomatic relief along with significant reduction in dysphagia score. Blunt dissection technique is a safe technique of laparoscopic Hellers’s myotomy in patients with achalasia cardia.
KeywordsAchalasia cardia Laparoscopic Heller’s myotomy Cardiomyotomy Technique Blunt dissection
Compliance with Ethical Standards
Conflict of Interest Disclosure
All authors declare that they have no conflict of interest.
Ethics Committee Approval Disclosure
Ethics committee approval was not required for this study.
Informed Consent Disclosure
Informed consent was obtained from all the patients/relatives included in this study.
- 3.Heller E (1913) Extramucöse Cardioplastiebeim chronischen Cardiospasmusmit Dilatation des Oesophagus. Mitt Grengeb Med Chir 2:141–149Google Scholar
- 4.De Brune Groenveldt JR (1918) Over cardiosphasmus.Ned Tijdschr Geneeskd 54:1281 1282Google Scholar
- 5.Shimi S, Nathanson LK, Cuschieri A (1991) Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 36:152–154Google Scholar
- 7.Palanivelu C, Maheshkumar GS, Jani K (2007) Minimally invasive management of achalasia cardia: results from a single center study. J Soc Laparoendosc Surg 11:350–357Google Scholar
- 8.Kathy S, Hajdu Z, Bokor L et al (1997) Use of harmonic scalpel at laparoscopic cardiomyotomy. A new method. Acta Chir Hung 36(1–4):154–155Google Scholar
- 14.Spiess AE, Kahrilas Treating achalasia: from whale bone to laparoscope. JAMA 280:638-42Google Scholar