[Role of laparoscopic surgery in the treatment of achalasia: an analysis of 50 cases]

Abstract

Achalasia is an uncommon oesophageal motor disorder, with a controversial therapeutic management.

Aim: The aim of our study was to analyse our experience in the management of achalasia, assessing the impact of minimally invasive surgery, its complications and its outcomes in the short and medium term.

Methods: A retrospective and descriptive study was designed, including all patients operated on between 1999 and 2010 with the diagnosis of achalasia. Previous diagnostic tests, duration of symptoms, previous non-surgical treatment, surgical approach, associated antireflux intervention, surgical time and perioperative complications were analysed.

Results: A total of 50 patients, 24 males and 26 females, with a mean age of 47 years underwent laparoscopic surgery. The mean duration of the disease was 2 years. Eleven (22%) patients had received endoscopic treatment (1-4 sessions) prior to the surgery, with 100% of symptomatic recurrence. The surgery was accompanied by a Dor fundoplication in 48 patients, and Toupet fundoplication in the remaining two. The mean surgical time was 123 minutes. There were 9 intraoperative complications (5 gastric mucosal perforations, 2 bleeding, 1 liver injury and 1 aspiration); 4 postoperative complications (3 scapular pain and 1 sub-phrenic collection) were reported. The long-term subjective symptomatic response was excellent/good in 84% of patients, intermediate in 12% and a poor response in 4%. The mean follow-up was 28 months.

Conclusions: Heller cardiomyotomy should be the treatment of choice in selected Achalasia patients, because of its short and long term outcomes, and its low morbidity.