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lüll Clinical results of thoracoscopic Heller s myotomy in the treatment of achalasia Codispoti M; Soon SY; Pugh G; Walker WSEur J Cardiothorac Surg 2003[Oct]; 24 (4): 620-4OBJECTIVES: Ideal treatment for achalasia permanently eliminates the dysfunctional lower oesophageal sphincter, relieving dysphagia and regurgitation. The aim of this study was to review the results in a series of patients undergoing video-imaged thoracoscopic Heller's myotomy (THM). METHODS: Records of all patients undergoing THM by a single surgeon at one institution were analysed. Follow-up was conducted using a structured questionnaire together with oesophageal manometry and/or 24 h pH monitoring when clinically indicated. RESULTS: Twenty-five consecutive patients (13 males, 12 females, mean age 40.3+/-19.9 years) suffering from grade 4 dysphagia underwent THM between 1993 and 2001. Preoperative mean lower oesophageal sphincter (LOS) pressure was 42.6+/-6.3 mmHg. Seven patients (28%) had undergone previous pneumatic dilatations. There were no hospital deaths and no oesophageal perforations. Length of hospital stay was 4.3+/-1.8 days. One patient died 3 years after surgery from unrelated causes. At follow-up of 5.4+/-2.1 years, freedom from any reintervention was 95.8% (23/24). Eleven patients (45.8%) were asymptomatic. In patients with residual or recurrent symptoms (n=13), their severity was significantly reduced from the preoperative period (dysphagia score 1.7+/-0.8 versus 4+/-0; P=0.05). Four patients (16%) with troublesome residual or recurrent grade 3-4 dysphagia underwent repeat oesophageal manometric study, showing a mean reduction in LOS pressure from their baseline values of 46.8+/-6.1 to 30+/-5.4 mmHg (P=0.01). One of these patients (4.2%) required repeat Heller's myotomy 1.5 years after THM. Six patients complained of troublesome postoperative heartburn; distal oesophageal acid exposure was shown to be abnormal in 3 (12.5%) of these patients and all enjoyed symptomatic relief with medical therapy. CONCLUSIONS: THM is a safe and effective procedure in the treatment of achalasia. Some patients do experience recurrence of symptoms; however, these are significantly less severe. The incidence of postoperative heartburn is acceptably low and can be controlled with oral medications, making the addition of an anti-reflux procedure not necessary. Longer-term follow up and randomised studies comparing THM to other therapeutic modalities are needed to ascertain respectively the durability of this approach and its relative advantages.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Deglutition Disorders/surgery[MESH]|Esophageal Achalasia/*surgery[MESH]|Esophagogastric Junction/*surgery[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Hydrogen-Ion Concentration[MESH]|Length of Stay[MESH]|Male[MESH]|Manometry[MESH]|Middle Aged[MESH]|Recurrence[MESH]|Severity of Illness Index[MESH]|Thoracic Surgery, Video-Assisted/*methods[MESH]|Treatment Outcome[MESH] |