Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation.

摘要: Initial care for achalasia is often provided by nonsurgeons and, thereby, many patients have been initially treated with botulinum toxin (Botox) or undergone balloon dilation prior to considerations myotomy. Over the last decade, however, laparoscopic approaches become widely available and experience has grown, as documented favorable results from centers.1–8 Laparoscopic Heller myotomy evolving into a “first-line” therapy achalasia, well definitive salvage of failing endoscopic achalasia. now undertaken at enough centers long that full picture should be coming focus. We undertook our first in 1992. We prospectively followed since then, building upon earlier via celiotomy thoracotomy. While initial videoscopic myotomies were through thoracoscopy, after less than 20 patients, we converted approach involve laparoscopy because perceived simplicity superior outcomes. Our thoracoscopy documented,9 believed they inadequate justify continuing approach. Many questions over past decade arisen regarding outcomes myotomy, including frequency severity gastroesophageal reflux, need an antireflux fundoplication, intraoperative endoscopy, extent robotics, long-term relief dysphagia. As well, rates success failure sought, interventions revisions myotomy. This report documents began undertaking myotomies. This encompasses journey results, delineates current approach. In this review experience, sought address several key issues, specifically, complications associated determined patient judgment, reinterventions. hypothesized reviewing cumulative following (as judged patients) would very high, relatively infrequent, though late recurrence symptoms consequences reflux occur.