Surgical correction of achalasia using laparoscopic Heller myotomy with Dor fundoplication is argued to be the gold standard treatment for patients with achalasia. The goal of this technical report is to illustrate our preferred approach to patients with achalasia and to provide the reader with a detailed description of our operative technique, its rationale, and our pre and postoperative management.
Get full access to this article
View all access options for this article.
References
1.
WillisT. Pharmaceutice Rationalis Sive Diatribe de Medicamentorum Operationibus in Humano Corpore. London: Hagae-Comitis, 1674.
2.
SadowskiDC, AckahF, JiangB, SvensonLW. Achalasia: Incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil, 2010; 22:e256–e261.
3.
SweetMP, NipomnickI, GasperWJ, et al.The outcome of laparoscopic heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg, 2008; 12:159–165.
4.
WeberCE, DavisCS, KramerHJ, GibbsJT, RoblesL, FisichellaPM. Medium and long-term outcomes after pneumatic dilation or laparoscopic heller myotomy for achalasia: A meta-analysis. Surg Laparosc Endosc Percutan Tech, 2012; 22:289–296.
5.
PerssonJ, JohnssonE, KosticS, LundellL, SmedhU. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: Long-term results of a prospective, randomized study. World J Surg, 2015; 39:713–720.
6.
InoueH, MinamiH, KobayashiY, et al.Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy, 2010; 42:265–271.
7.
RenZ, ZhongY, ZhouP, et al.Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc, 2012; 26:3267–3272.
8.
EckardtVF, GockelI, BernhardG. Pneumatic dilation for achalasia: Late results of a prospective follow up investigation. Gut, 2004; 53:629–633.
9.
FamiliariP, GiganteG, MarcheseM, BoskoskiI, TringaliA, PerriV, et al.Peroral endoscopic myotomy for esophageal achalasia: Outcomes of the first 100 patients with short-term follow-up. Ann Surg, 2016; 263:82–87.
10.
WernerYB, CostamagnaG, SwanstromLL, von RentelnD, FamiliariP, SharataAM, et al.Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut, 2015; 0:1–8.
11.
LeeuwenburghI, ScholtenP, AlderliestenJ, et al.Long-term esophageal cancer risk in patients with primary achalasia: A prospective study. Am J Gastroenterol, 2010; 105:2144–2149.
12.
SandlerRS, NyrenO, EkbomA, EisenGM, YuenJ, JosefssonS. The risk of esophageal cancer in patients with achalasia. A population-based study. JAMA, 1995; 274:1359–1362.
13.
AndolfiC, KavittRT, HerbellaFA, PattiMG. Achalasia and respiratory symptoms: Effect of laparoscopic Heller myotomy. J Laparoendosc Adv Surg Tech A, 2016. DOI: 10.1089/lap.2016.0246.
14.
EckardtAJ, EckardtVF. Treatment and surveillance strategies in achalasia: An update. Nat Rev Gastroenterol Hepatol, 2011; 8:311–319.
15.
PandolfinoJE, KwiatekMA, NealisT, BulsiewiczW, PostJ, KahrilasPJ. Achalasia: A new clinically relevant classification by high-resolution manometry. Gastroenterology, 2008; 135:1526–1533.
16.
AndolfiC, BonavinaL, KavittRT, KondaVJA, AstiE, PattiMG. Importance of esophageal manometry and pH monitoring in the evaluation of patients with refractory gastroesophageal reflux disease: A multicenter study. J Laparoendosc Adv Surg Tech A, 2016; 26:548–550.
17.
Liebermann-MeffertD, AllgöwerM, SchmidP, BlumAL. Muscular equivalent of the lower esophageal sphincter. Gastroenterology, 1979; 76:31–38.
18.
FisichellaPM, PattiMG. From Heller to POEM (1914–2014): A 100-year history of surgery for Achalasia. J Gastrointest Surg, 2014; 18:1870–1875.
19.
ZaninottoG, RizzettoC, ZambonP, GuzzinatiS, FinottiE, CostantiniM. Long-term outcome and risk of oesophageal cancer after surgery for achalasia. Br J Surg, 2008; 95:1488–1494.
20.
Ben-David, et al.Esophageal perforation management using a multidisciplinary minimally invasive treatment algorithm. J Am Coll Surg, 2014; 218:768–774.
21.
OnimaruM, InoueH, IkedaH, YoshidaA, SantiEG, SatoH, et al.Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: A single center prospective study. J Am Coll Surg, 2013; 217:598–605.
22.
PattiMG, FeoCV, DienerU, et al.Laparoscopic heller myotomy relieves dysphagia in achalasia when the esophagus is dilated. Surg Endosc, 1999; 13:843–847.
23.
FaccaniE, MattioliS, LugaresiML, Di SimoneMP, BartalenaT, PilottiV. Improving the surgery for sigmoid achalasia: Long-term results of a technical detail. Eur J Cardiothorac Surg, 2007; 32:827–833.
