[Laparoscopic myotomy in 14 patients with achalasia after unsuccessful pneumatic dilatations: effective and safe].

OBJECTIVE: Evaluation of laparoscopic myotomy with or without an anti-reflux (Dor) procedure in patients with achalasia. DESIGN: Retrospective. METHOD: Data were collected from patients who underwent a laparoscopic myotomy for achalasia, following repeated pneumatic dilations. In the period 1993-1998, seven patients were treated in the Dijkzigt location of the Erasmus University Hospital (Rotterdam, the Netherlands). In the period 1995-1999 seven patients were treated in the Free University Hospital (Amsterdam, the Netherlands) by means of a laparoscopic myotomy followed by Dor fundoplication. All of the patients received a check-up from their specialist according to a protocol and in 2000 they were requested to complete a questionnaire concerning how satisfied they were with the operation. RESULTS: In both groups the age ranged from 20 to 60 years (mean ages were 39 and 36 respectively) and the number of men and women was almost equal. There was no conversion. Average operation time was 1.5 hours for the group without fundoplication and 2.5 hours for the group with fundoplication. No perioperative or postoperative complications occurred. During the follow-up period (mean: 3.5 years; range: 1-7) one recurrence was encountered. In the group without fundoplication, reflux oesophagitis was observed in five of the patients. No reflux was encountered in the group with the added fundoplication. All of the patients preferred laparoscopic myotomy to pneumatic dilations. CONCLUSION: Laparoscopic myotomy was an effective and safe treatment for achalasia following repeated pneumatic dilations. The patients themselves were also satisfied. Without fundoplication, reflux oesophagitis was more prevalent.