Laparoscopic Heller's Myotomy for Achalasia Cardia: An Outcome and Experience of a Single-Center Study

Background: Achalasia cardia is a rare disease mostly caused by myenteric plexus degeneration. The main clinical presentations are dysphagia, regurgitation, chest pain, and weight loss. Objectives: This study aimed to evaluate the feasibility and outcome of laparoscopic Heller's myotomy. Methods: This is a prospective study involving 52 patients with achalasia diagnosed by OGD, barium swallow, and esophageal manometry. All patients underwent laparoscopic surgery. Results: This study includes 23 males and 29 females with a male/female ratio of 1.26. The mean age of patients was 36.8 years. The mean operative time was 85.12 minutes, with a mean hospital stay of 4.27 days. All patients had undergone laparoscopic Heller's myotomy with Dor fundoplication; there were no conversions to open surgery. Intraoperatively detected complications involve 4 patients with esophageal mucosal injury, 1 patient with gastric mucosal injury, and 2 patients with minute pleural injury and no significant intraoperative bleeding, adjacent organ injury, or surgical emphysema. Regarding the early postoperative complications, 3 patients (5.76%) had atelectasis, 1 patient (1.92%) had pneumonia, and 1 patient (1.92%) had a leak due to a missed esophageal mucosal injury discovered on the third postoperative day; 3 patients (5.88%) with mild dysphagia were successfully treated conservatively, and one patient (1.92%) died on the sixth postoperative day. About late complications, 4 patients (7.84%) developed mild GERD, and 1 patient developed recurrent dysphagia. Conclusions: Laparoscopic Heller's myotomy is feasible and effective therapy for achalasia cardia. DOR fundoplication is a competent anti-reflux procedure to decrease the rate of postoperative GERD.