This study evoluote the new trend of using lnporoscopic approach of
cardio - Oesophageal rnyotorny with Dor - type anterior fundoplication for
oesophageal acholo sia. The Study included /2 patients, 8 females, 4
moles whose age ranged from 35-60years, they presented with dysphagia
with regurgitation, due to achalasia of the cardia, they were subjected
to full clinical, laporatory investigations, in addition to upper fibreoptic endoscopy,
barium swallow and motility study for the lower oesophageal
sphincter pressure, they were operated upon laparoscopically, conversion
to laparotomy was required in two patients, no operative mortality occured,
post operative complications, incluriPd one left sub diaphragmatic
abcess secondary to oesophageal mucosal tear which was sutured at
open laparotomy, and pleural effusion in two patients responded to conservative
medical treatment, disappearance of dysphagia was reported in
10 patients and persisted in two patients whom responded to pneumatic
dilatation, post operative manometric study of the lower oesophageal
sphincter pessure showed reduction of the pressure from mean 25.4 ram.
Hg to mean 14.5 nun. Hg. with no post operative reflux oesophagitis,
whicht tends toward statistically significance (p = 0.08), after follow up
ranged from 8 monthes to two years, therfore we concluded that, cardiomyotomy
with Dor fundoplication through a laparoscopic approach seem
to be effective in management of oesophageal achalasia and is superior
to pneumatic dilatation.
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