Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 7-8, Pages: 475-481
https://doi.org/10.2298/SARH1308475B
Full text ( 2559 KB)
Laparoscopic myotomy in achalasia cardia treatment: Experience after 36 operations
Bjelović Miloš (Medicinski fakultet, Beograd + Klinički centar Srbije, Prva hirurška klinika, Centar za hirurgiju jednjaka, Beograd)
Špica Bratislav (Klinički centar Srbije, Prva hirurška klinika, Centar za hirurgiju jednjaka, Beograd)
Gunjić Dragan (Klinički centar Srbije, Prva hirurška klinika, Centar za hirurgiju jednjaka, Beograd)
Grujić Danko (Opšta bolnica, Užice)
Skrobić Ognjan (Klinički centar Srbije, Prva hirurška klinika, Centar za hirurgiju jednjaka, Beograd)
Babič Tamara (Medicinski fakultet, Beograd)
Peško Predrag (Medicinski fakultet, Beograd + Klinički centar Srbije, Prva hirurška klinika, Centar za hirurgiju jednjaka, Beograd)
Introduction. Laparoscopic HellerDor operation, a standard method in the
treatment of achalasia, has been performed at the Center for Esophageal
Surgery of the First Surgical Clinic since April 2006. Objective. The aim of
this study was to present this surgical procedure and initial experiences
after 36 consecutive laparoscopic HellerDor operations. Methods. This partly
retrospective, partly prospective study presented our results after
laparoscopic HellerDor operation (presentation of the treatment method). We
performed a standard anterior esophagocardioymiotomy, without releasing the
posterior aspect of the cardia, and anterior partial fundoplication. The
type and severity of symptoms and their duration were evaluated based on
questionnaires fulfilled by patients. The diagnosis was made based on
radiological, endoscopic and manometric findings. Laparoscopic surgery as the
method of treatment was evaluated based on the duration of surgery, intra
and postoperative complications, time interval until the initiation of oral
feeding, length of hospital stay, need for additional therapeutic measures
after the operation and effect of surgery on the severity of symptoms.
Results. Preopereratively, dysphagia was the predominant symptom in all
patients, while regurgitation was much lower (44%). The average duration of
operation was 127 minutes. Postoperative hospitalization lasted on the
average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the
effect of treatment was good or excellent. Postoperative dysphagia was
present in two patients (5.6%) and was successfully solved by balloon
dilatation. Conclusion. Laparoscopic HellerDor operation is an effective and
safe surgical procedure in resolving symptoms of achalasia and today presents
the method of the first choice in the treatment of this disease.
Keywords: achalasia, HellerDor, minimally invasive surgery