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. |
