Page 3 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):1-3
Minimal Access Surgery (Laparoscopic Cardiomyotomy) for Achalasia Cardia
Minimal Access Surgery

(Laparoscopic Cardiomyotomy)

for Achalasia Cardia

Hemant Patil
Member of World Association of Laparoscopic Surgeons, Mumbai, Maharashtra, India

Abstract MATERIAL AND METHODS
Background: Primary motor disorder of esophagus is achalasia cardia
which is progressive in nature and do not have any definitive A literature search was performed using Pubmed, search engine
cure.Esophageal cardiomyotomy is the palliative method of treatment Google, Springer link and Highwire press.The following search
which forms the backbone of the treatment line of management. Over terms was used-minimal access cardiomyotomy, laparoscopic
a period of last few years minimal access surgery is ganing popularity cardiomyotomy, esophageal achalasia cardia and Heller’s
as the primary modality of management for achalasia.We present our cardiomyotomy. More than 500 citations found. Selected papers
review study of laparoscopic cardiomyotomy and discuss the relevant were screened for further references.Criteria for selection of
issues. literature were the number of cases (excluded if less than 20),
Method: A retrospective analysis was carried out of various studies method of analyses (statistical or nonstatistical), operative
who presented the large series of patients who underwent Minimal
access cardiomyotomy (laparoscopic) at their respected centers.All procedures (only universally accepted procedure were
patient related factors,the surgical techniques,post-operative course selected)and the institution where the study was done
and management including follow-up are discussed. (specialized institution for minimal access surgery).
Results: Minimal access approach showed less postoperative pain,
ileus, less requirement of intravenous nutrition (P < 0.0001) conse- INTRODUCTION
quently hospital stay, interval resuming the normal routine activity
were also shorter (5 to 15 for minimal access surgery group versus 10 Achalasia cardia is one of the most commonly diagnosed motor
to 20 days for the open heller cardiomyotomy group (P < 0.0001). and functional disorder of the esophagus. Failure of relaxation
Conclusion: Minimal access surgery for achalasia is becoming more of lower esophageal sphincter, poor body peristalsis and a high
and more popular over conventional open cardiomyotomy in view of pressure zone at lower sphincter are the characteristic findings.
its equal safety and efficacy with added advantage of less Decreased number or absence of ganglionic cells in the
morbidity,mortality and better quality of life. Aurbach’s plexus results in the major pathophysiological
Keywords: Esophagus, achalasia cardia, minimal access surgery, changes including uncoordinated peristalsis, esophageal stasis
laparoscopy, Heller’s cardiomyotomy.
resulting into dilatation and elongation of the esophagus.
AIMS AND OBJECTIVES Diagnosis can be done by Barium swallow, upper GI endoscopy
The aim of this study was to compare the effectiveness and with biopsy. Esophageal manometry and 24 hours pH study
safety of minimal access cardiomyotomy and conventional requires for decision of surgery.
Heller’s cardiomyotomy in the treatment of esophageal achalasia
cardia. CONTENT
The following parameters were evaluated for both minimal
access and open procedures: He was Heller, who performed first esophagomyotomy in 1913.
1. Method of patient selection. He described both anterior and posterior myotomy. In 1923
2. Operative techniques. Zaaiger modified it by doing single anterior myotomy and
3. Operative time. proposed the same results. Laparoscopic era started with
4. Intraoperative and postoperative complications. Pellegrini who performed the first minimal access surgery of
5. Postoperative pain and amount of narcotics used. cardiomyotomy by thoracoscopic approach in 1991. Since then
6. Time untill resumption of diet. various studies performed at various institutions to compare or
7. Postoperative morbidity. too prove the efficacy of the minimal access surgery.
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8. Hospital stay. Hajdu Z et al in their studies 21 patients evaluated the
9. Cost effectiveness and results which states that laparoscopic approach leeds to good
10. Quality of life analyses. functional results and seems effective and safe procedure in

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