Laparoscopic graduated cardiomyotomy with anterior fundoplication as treatment for achalasia: experience of 48 cases

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Abstract

Introduction and aims: At the Upper Gastrointestinal Tract Clinic of the Hospital General de Mexico, achalasia treatment has been standarized through strictly graduated cardiomyotomy. This procedure guarantees a complete myotomy for the satisfactory resolution of dysphagia, a characteristic symptom of achalasia. To ensure the inclusion of the entire lower esophageal sphincter, an 8 cm Penrose drain is placed at the surgical site 6 cm above the gastroesophageal junction and 2 cm in a caudal direction, for accurate laparoscopic measuring. The aim of our study was to evaluate the results of this technique. Materials and methods: A descriptive, retrospective, longitudinal, and observational study was conducted on a cohort of patients diagnosed with achalasia at the Upper Gastrointestinal Tract Clinic of the Hospital General de México “Dr. Eduardo Liceaga”. Results: The study included 48 patients, 40 of whom had no prior surgical treatment and 8 that presented with recurrence. Forty-seven patients (97.9%) underwent a laparoscopic procedure and conversion to open surgery was required in 2 of them (4.25% conversion rate). Postoperative progression was satisfactory in all cases, with mean oral diet commencement at 52 h and mean hospital stay of 5.7 days. No recurrence was registered during the mean follow-up period of 35.75 months and there were no deaths. Conclusions: Laparoscopic graduated (strictly measured) cardiomyotomy with anterior fundoplication is a reproducible, efficacious, and safe option for the surgical treatment of achalasia.

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Etchegaray-Dondé, A., Rodríguez-Espínola, G., Higuera-Hidalgo, F., Ortiz-Higareda, V., Chapa-Azuela, O., & Etchegaray-Solana, A. (2018). Laparoscopic graduated cardiomyotomy with anterior fundoplication as treatment for achalasia: experience of 48 cases. Revista de Gastroenterologia de Mexico, 83(2), 106–111. https://doi.org/10.1016/j.rgmx.2017.05.005

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