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Laparoscopic Heller myotomy for achalasia: changing trend toward "true" day-case procedure.

Agrawal, Sanjay and Super, Paul (2008) Laparoscopic Heller myotomy for achalasia: changing trend toward "true" day-case procedure. Journal of laparoendoscopic & advanced surgical techniques. Part A, 18 (6). pp. 785-8. ISSN 1092-6429.

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Official URL: http://online.liebertpub.com/doi/abs/10.1089/lap.2...

Abstract

BACKGROUND

Laparoscopic Heller myotomy is the most effective therapy for achalasia. All case series have reported a minimum length of stay of more than 1 day. "True" day-case laparoscopic Heller myotomy has not been reported, so far. The aim of this study was to review our results with laparoscopic Heller myotomy with respect to the length of stay following the procedure.

METHODS

All patients undergoing laparoscopic Heller myotomy between August 2000 and July 2007 under the care of one surgeon were included in the study. This was performed by incising 6 cm of distal esophageal musculature, extending to 2 cm below the gastroesophageal junction. The myotomy was covered by an anterior fundoplication. All patients were reviewed in the clinic at a median of 6 weeks after surgery and, thereafter, if necessary.

RESULTS

Over the 7-year period, 24 consecutive patients with achalasia were treated in this manner. There were 13 women and 11 men, with an age range of 12-73 years. Intraoperative complications included mucosal perforation in 2 patients (sutured immediately) with no postoperative complications or conversion to open surgery. There were no deaths. The average length of stay was 1.9 days (range, 0-4). The last 2 patients were discharged on the same day, and the 5 previous to this were discharged within 23 hours of surgery. There were no adverse outcomes related to early discharge, and there were no readmissions. All patients reported good to excellent results with a relief of dysphagia on follow-up. Three patients (12%) developed recurrent dysphagia after an initial improvement, requiring dilatation only several months later.

CONCLUSIONS

Based on our own experience, we believe that laparoscopic Heller myotomy with anterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia. It is well tolerated and can be considered a true day-case procedure.

Item Type: Article
Subjects: WI Digestive system. Gastroenterology
WO Surgery
Divisions: Ambulatory Care > Day Care Unit
Emergency Services > Therapies
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 10 Jun 2014 13:27
Last Modified: 10 Jun 2014 13:27
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/158

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