pLaparoscopic Heller's Cardiomyotomy for Achalasia of the Cardia with adding an antireflux procedure to provide better surgical outcomes
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Purposes: Find out advantages of Laparoscopic Heller's Cardiomyotomy & how to give better surgical outcomes by adding an antireflux procedure. Background:Achalasia cardia is progressive in nature & don't have any definitive cure. Esophageal cardiomytomy forms the backbone of the treatment. Over a period of last few years; minimal access surgery is gaining popularity as primary modality of achalasia management. Patients and methods: The study included 36 patients; 7 (19.5%) 20years old, 24 (66.8%) between 20-35 years old and 5 (13.8%) above 35 years old. All patients underwent clinical evaluation, laboratory assessment, upper OTT Endoscopy & Esophageal manometry. All patients undergoing laparoscopic cardiomytomy; followed by either a modified Toupet fundoplication (2700 posterior fundoplication, or a Dor fundoplication (1800 anterior firidoplication). Results: There was satisfactory relief of Dysphagia in all surgery performed (P-Value =0.011); but low incidence of postoperative reflux was noticed only in modified Toupet fundoplication (P-Value <0.05). There was a significant improvement in regurgitation, epigastric pain and cough; but There was no significant difference in the severity of heartburn. The effect on regurgitation appeared to be most marked, improving from mean 3.9 to mean 0.7 post operative.