This study was designed to evaluate the success rate of stepwise
endoscopically-guided laparoscopic Heller myotomy (LHM) for management of
achalasia of the cardia in comparison to LHM without endoscopic guidance and
comprised 18 patients allocated in 2 equal (n=9) groups: Group A included patients
assigned to undergo endoscopically-guided LHM and Group B included patients
underwent surgery without endoscopic guidance. After full history taking, complete
physical examination, routine laboratory and radiological examinations and upper
gastrointestinal endoscopy and motility studies, patients underwent LHM that in
group A, encompassed intraoperative illumination of the esophageal lumen using
endoscopy to facilitate identification and piecemeal dissection of the esophagus.
Intraoperative morbidity, duration of surgery, postoperative hospital stay and
occurrence of postoperative complications were reported. No case required shift to
open procedure and no perforation had occurred in group A, whereas 2 cases of
small perforation occurred in group B. There was a significant reduction of the
operative time (559 vs. 64.49.5 min) and postoperative hospital stay (3.21 vs.
4.81.4 days) in group A compared to group B. There were 3 cases with mild reflux
symptoms; two in group B and one in group A, both cases responded to medical
treatment and one case in group B with persistent symptoms required endoscopic
balloon dilation with a significant reduction in frequency ofintra- and postoperative
complications in favor of group A. It could be concluded that LHM is a safe and
effective minimally invasive procedure for treatment of achalasia of the cardia with
more favorable outcome and short operative time and hospital stay when performed
endoscopically-guided
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