Page 4 - WJOLS - Surgery Journal

Hemant Patil
the treatment of esophageal achalasia. A 3.3 years follow-up DISCUSSION
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study by Yasser-Youssef, et al after laparoscopic Heller’s Minimal access cardiomyotomy (laparoscopic cardiomyotomy)
myotomy proved that minimal access approach via laparoscopy has got lot of attention around the world. Several controlled
offers a excellent long-term relief of the symptoms namely trials have been conducted, some are in favour of laparoscopy
dysphagia and also stated that their was significant improve- others not.The goal of this review was to ascertain that if
ment in the quality of life and patient satisfaction. minimal access cardiomyotomy is superior to conventional
Large single center study of 226 patients done by Palanivelu
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C et al suggested that average operative time for laparoscopic and if so, what are the benefits and how it could be instituted
myotomy was 96 minutes. Mean postoperative hospital stay more widely.There is also divercity in the quality of
was 2.2 days. The overall morbidity was 4.4% and nil mortality randomized trials.The main variable in these trials are following
was observed over mean follow-up 4.3 years. They concluded parameters:
the study suggesting that minimal access surgery is a safe and 1. Number of patients in trial
effective treatment for achalasia cardia. 106 patients were 2. Withdrawal of cases
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studied by M Robert, et al proving that the morbidity rate 3. Exclusion of cases
with average follow-up of 55 months was very less. They stressed 4. Blinding
the importance of the minimal access cardiomyotomy which 5. Intention to treat analysis
gives good functional results. 6. Publication biases
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One of the oldest study done by Ancona E el al compared 7. Local practice variations
the open cardiomyotomy with laparoscopic cardiomyotomy. 8. Prophylaxis, antibiotics used
Laparoscopic approach took longer time then open procedure 9. Follow-up failure.
(mean 178 versus 125 minutes). No major morbidity or mortality
was observed in any group. But when compared the post- CONCLUSION
operative pain, ileus and IV nutrition the minimal access The advent and the success of minimal access surgery have
technique was much superior ( P < 0.001). changed the treatment algorithm of the esophageal achalasia.
Minimal access approach through thoracoscopy and Minimal access cardiomyotomy for achalasia is becoming more
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laparoscopy was also compared by Cade R which also and more popular over conventional open cardiomyotomy in
mentioned that minimal access approach are very safe. view of its equal safety and efficacy with added advantage of
Laparoscopic Heller’s myotomy has comparable success to less morbidity,mortality and better quality of life.
open Heller’s myotomy and causes less early detriment in the
quality of life and should be the primary treatment in all fit REFERENCES
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