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An early experience in the surgical management of Achalasia Cardia: Laparoscopic Heller’s Cardiomyotomy

Shrenik Govindaraj, Rithvik G, Mallikarjun Patil, Sridar Govindaraj.

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Background. The surgical treatment of achalasia cardia is Heller’s cardiomyotomy with the intent of relieving symptoms. Most studies have included an antireflux procedure. With the advent of minimal access surgery, surgical results and patient satisfaction have improved significantly. This article describes our initial experiences with laparoscopic Heller’s myotomy without antireflux in the treatment of achalasia.
Methods. This was a prospective study from February 2019 to February 2022. We recruited 19 patients with AC undergoing laparoscopic Heller’s myotomy and analyzed their data in terms of demography, symptoms, duration, investigations, and postoperative outcomes. The primary outcome was the relief of their symptoms, mainly dysphagia, heartburn, and regurgitation.
Results. All patients with suspected AC were investigated with endoscopy and high-resolution manometry to confirm the diagnosis. Fourteen patients opted for surgery as a primary modality, while five opted for surgery after failed pneumatic dilatation. All underwent laparoscopy with no conversion. There were no significant morbidity and mortality. In the immediate follow-up period, there was a 100% resolution of their symptoms. However, on long-term follow-up, 2 (10.5%) patients developed reflux symptoms, 3 (15.8%) developed heartburn, and 1 (5.3%) developed mild dysphagia. All underwent endoscopy, which showed an excellent myotomy with a scope negotiating through the LES without resistance. Their symptoms resolved with conservative treatment.
Conclusions. Laparoscopic Heller’s myotomy without antireflux procedure is a good treatment option in achalasia, with a resolution of symptoms and without significant reflux symptoms.

Key words: Laparoscopy, Heller’s myotomy, Esophagus, Achalasia

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