Abstracts
1998 Digestive Disease Week

#961

CLINICAL AND FUNCTIONAL RESULTS OF PRIMARY LAPAROSCOPIC MYOTOMY AND ANTERIOR FUNDOPLICATION FOR ESOPHAGEAL ACHALASIA. L.Bonavina, G.Micheletto, M.Pagani, L.Antoniazzi, R.Rosati, A.Segalin, G.Marotta, and A.Peracchia. Department of Surgery, University of Milan School of Medicine, Milan, Italy.

Long-term results of Heller myotomy and Dor fundoplication have been highly satisfactory. Aim of this study was to verify whether similar results can be achieved laparoscopically. Methods. Between April 1992 and May 1997, 51 patients underwent laparoscopic myotomy and anterior fundoplication for esophageal achalasia. None of them had previously been treated either endoscopically or surgically. There were 32 females and 19 males; the median age was 37 yrs (range 9-67 ). The cardia was not mobilized except in patients with sigmoid esophagus. The myotomy was carried out for at least 5 cm on the esophagus and 1.5 cm on the gastric side. Results. The median operative time was 100 minutes (range 60-200). Postoperative complications occurred in 2 patients and consisted of bleeding from an acute gastric ulcer and from a port site, respectively. The median hospital stay was 4 days (range 3-8). After a median follow-up of 22 months (range 6-65), the mean dysphagia score decreased from 2.2 to 0.3. The mean esophageal diameter on standard barium swallow study decreased from 4.0 to 2.5 cm (p<0.04). Lower esophageal sphincter (LES) pressure decreased from 30.6 to 11.3 mmHg (p<0.0001); LES residual pressure decreased from 14.6 to 2.9 mmHg (p<0.0001). Radionuclide esophageal activity at 1 and 10 minutes decreased from 88.5% to 23.2% and from 84.2% to 9.7%, respectively (p<0.0001). Abnormal gastroesophageal reflux was documented by 24-hour esophageal pH monitoring in one patient (1/10 tested, 10%) in whom the cardia was mobilized to reduce in the abdomen a sigmoid esophagus. Conclusions. Laparoscopic myotomy combined with anterior fundoplication is a safe and effective procedure. Cardia mobilization may increase the risk of postoperative gastroesophageal reflux.

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