Laparoscopic management of idiopathic esophageal achalasia.

INTRODUCTION: Idiopathic esophageal achalasia was described in 1682 as a motor disorder of smooth muscle. In 1913 transabdominal cardiomyotomy was introduced and in 1958 this technique was popularized via a left thoracotomy, in 1991 laparoscopic cardiomyotomy was introduced since then many surgeons have adopted this technique as the primary treatment of esophageal achalasia. OBJECTIVE: Evaluate usefulness and recent advances in endoscopic surgery for the management of esophageal achalasia, as well as general issues in clinical presentation and diagnosis. METHODS: We did a review of the medical literature and of our series of patients treated between 1996 and 2004. RESULTS: Between 1996 and 2004, 84 patients underwent laparoscopic Heller myotomy and partial funduplication (78 Toupet and 6 Dor) for the treatment of achalasia. Operative time ranged from 2 to 3 hours with a mean of 2.5 hours. Mucosal perforation (esophageal/gastric) occurred in 3 patients and was repaired with primary closure. During follow-up 3 patients required postoperative endoscopic dilation and one required reoperation due to adhesions causing angulation of the g-e-junction. CONCLUSIONS: Laparoscopic Heller myotomy provided marked reduction in dysphagia, with minimal complaints of regurgitation, heartburn and chest pain at a mean follow-up of 2 years.