Publication:

Laparoscopic management of achalasia cardia

Background Primary idiopathic Achalasia is a quite rare disease. Achalasia Cardia is a motor disorder of the esophagus and lower esophageal sphincter. More specifically, it is a neuromuscular disorder characterized by degenerative changes of the myenteric plexus leading to a selective loss of inhibitory nerve endings. Irreversible disruption of peristaltic contractions and impaired relaxation of the lower esophageal sphincter in response to deglutition are the consequences of this damage. There is always a need to find out the best possible management options for this condition.

Methods We studied 22 cases of Achalasia Cardia in a span of 2 years from November 2012 to November 2014. To confirm the diagnosis we subjected the patients to barium swallow, upper GI endoscopy and CT scanning. Esophageal Manometry and 24hr PH monitoring were not done, because of non-availability of it in our institute. Operative technique used was Laparoscopic Heller’s Cardiomyotomy with Dor’s 180 degree Partial Anterior Fundoplication.

Results Following laparoscopic surgery there was significant improvement in preoperative symptoms like dysphagia (95.5%), regurgitation (95.5%), chest pain (90.90%) and epigastric pain (100%). After addition of anti-reflux procedure there was significant reduction in post-operative reflux without development of any dysphagia which has to be noted.

Conclusions Laparoscopic Heller’s Cardiomyotomy with Dor’s Procedure is feasible, safe and better than open procedures. Laparoscopic Heller’s Cardiomyotomy should be the management of choice in achalasia cardia in expert hands and proper setup.