Laparoscopic Heller's Myotomy and Fundoplication in Patients With Massive Dilated Megaesophagus
Carlos Pantanali1, Fernando a. Herbella*1, Maria a. Henry2, Jose F. Farah1, Marco G. Patti3, Jose C. Del Grande1
1Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil; 2Department of Surgery, State University of Sao Paulo, Botucatu, Brazil; 3Department of surgery, University of Chicago, Chicago, IL
INTRODUCTION: Laparoscopic Heller’s myotomy and fundoplication is considered the treatment of choice for non-advanced achalasia. The optimal treatment for end-stage achalasia with esophageal dilation is still debatable. AIMS: This study aims to evaluate in a multicenter and retrospective study the outcomes of patients with massive dilated esophagus submitted to laparoscopic Heller’s myotomy.METHODS: 11 patients (mean age 56 years, 6 men) with massive dilated megaesophagus (maximum esophageal diameter >10cm) underwent a laparoscopic Heller myotomy and Pinotti fundoplication between 2000 and 2009 at 3 different institutions. Preoperative workup included upper digestive endoscopy, esophagram and esophageal manometry in all patients. Symptoms were evaluated at the last follow-up.RESULTS: On follow-up (mean 29, range 3-81, months), postoperative complaints were mild and occasional dysphagia to solid food in 4 (36%), severe dysphagia in 3 (27%) and absence of dysphagia in 4 (36%) patients. All patients gained weight except for the 3 patients with severe dysphagia. The 3 patients with severe dysphagia underwent esophageal dilatation (n=2) or laparoscopic esophagectomy (n=1) and currently complain of occasional dysphagia and gained weight.CONCLUSION:.Heller’s myotomy and fundoplication relieves dysphagia even in patients with massive dilated esophagus.
Back to 2011 Program
