Akalazyalı Hastalarda Laparoskopik Modifiye Heller Myotomi ve Dor Fundoplikasyon Deneyimimiz

Abstract

INTRODUCTION: In this study we have retrospectively evaluated the patients which underwent laparoscopic modified Heller myotomy for achalasia.METHODS: Between January 2006 and January 2011, 20 patients underwent laproscopic Heller myotomy and Dor fundoplication in Istanbul Faculty of Medicine Department of General Surgery. The files of the patients were evaluated retrospectively.RESULTS: The mean age of the patients were 45.3± 10.9 years and female /male ratio was 1.86/1 (13/7). The mean symptom period was 17±4.9 months. In the preoperative period, 14(%70) patients underwent one, 6 (%30) patients underwent two times of pneumatic esophageal dilatation. Botox treatment was performed in 4 (%20) of the patients before the pneumatic dilatation. The mean lower esopghageal sphincter (LES) pressure of the patients was 24,2±11,6 mmHg. All of the patients were underwent laproscopic Heller myotomy and Dor fundoplication. The mean operation time was 62 ±17.6 minutes. The esophageal mucosal rupture occured in 1 (%5) patient during the operation and repaired laparoscopically. The mean hospitalization time was 2.3±0.6 days. The mean follow-up time was 26,2±20,2 months. No recurrence was occured during the follow-up period. Gastro-esophageal reflux (GER) was occurred in 2 (%10) patients with mild symptoms and treated medically. Port site hernia was occured in 1 (%5) patient.DISCUSSION AND CONCLUSION: Laproscopic Heller myotomy is the most effective treatment for esophageal achalasia. Because of the higher GER rates in patients without antireflux procedure, we recommend that Dor fundoplication should be added to the Heller myotomy.