In operative patients, results of Heller's cardiomyotomy and esophagoplasties are excellent.
Laparoscopic cardiomyotomy for achalasia: a single unit study.
Figure 1: The Chicago classification for achalasia subtypes (9) Type I Achalasia with minimal oesophageal (classic) pressurisation Type II Achalasia with oesophageal compression Type III Achalasia with oesophageal spasm Figure 2: Treatment options available for the management of achalasia Pharmacological Oral nitrates (GTN, Isosorbide dinitrate) options Calcium channel blockers (Nifedipine, verapamil) Anticholinergics Opioids (loperamide) Phosphodiesterase inhibitors *2 agonists Nitric oxide agonists Endoscopic Pneumatic balloon dilatation techniques Botulinum toxin injections Peroral endoscopic myotomy (POEM) Surgical Heller's
cardiomyotomy (transabdominal or options transthoracic / open or laparoscopic)
They were treated with transabdominal modified Heller's cardiomyotomy and anterior Dor patch as an antireflux procedure.
Conclusion: Transabdominal Heller's cardiomyotomy with anterior Dor patch is a safe and effective surgical option for achalasia cardia.
Adequate cardiomyotomy remains the main principle of surgery which is often combined with fundoplication as a prophylactic anti reflux procedure6.
Selection criteria was all patients of achalasia cardia operated through abdominal approach in whom modified Heller's cardiomyotomy with anterior Dor patch was performed.
Cardiomyotomy either by transabdominal or transthoracic approach remains the basic surgical aim.
In this study we chose transabdominal modified Heller's cardiomyotomy with anterior Dor patch as the surgical treatment.
Cardiomyotomy when carried out without any fundoplication has a higher incidence of post operative reflux symptoms.
Watson, "Laparoscopic
cardiomyotomy for achalasia: long-term outcomes," ANZ Journal of Surgery, vol.
There is an understandable reluctance to subject frail elderly patients to
cardiomyotomy. However,
cardiomyotomy is a remarkably safe operation(10) and a laparoscopic approach to it is an additional option; the outcome in elderly patients is not yet well defined.