Clinical and functional results of primary laparoscopic myotomy and anterior fundoplication for esophageal achalasia

Idiopathic achalasia is characterized by incomplete relaxation of the lower esophageal sphincther (LES) and impaired peristalsis of the esophageal body. Treatment is aimed to decrease the resistance to esophageal outflow. The introduction of a laparoscopic approach to perform a Heller myotomy has made surgery a more attractive option as a primary treatment. Between February 1993 and February 1998, 52 patients with esophageal achalasia underwent primary laparoscopic myotomy with anterior fundoplication in our Institution. Median postoperative hospital stay was 4 days. At a median follow-up of 28 months the dysphagia score decreased from 2.5+/-0.5 to 0.2+/-0.5 (p<0.01), and the LES pressure from 32.2+/-7.8 to 11.4+/-3.8 mmHg (p<0.01). Laparoscopic myotomy with anterior fundoplication is a safe and effective primary treatment for patients with esophageal achalasia.