Laparoscopic Heller Myotomy and Dor Fundoplication for Achalasia

Laparoscopic Heller myotomy and Dor fundoplication

70 year Caucasian old man with daily dysphagia for liquids and solids for several years, worsening in the past year, non-cardiac chest pain and chronic dry cough while swallowing, but no heartburn or weight loss. Patient was diagnosed with type 2 achalasia.

There were no contraindications.

Laparoscope
Ligasure

The patient lies supine on the operating table in low lithotomy position with the lower extremities extended on stirrups with knees flexed 20-30 degrees; a bean bag is inflated to avoid sliding of the patient; if possible an orogastric tube is placed to decompress the stomach; the surgeon stands between the patient's legs, while first and second assistant stand on the right and left side respectively.

EGD (normal), manometry (achalasia II), and barium swallow (bird's beak).

Excluding placement and removal of trocars, we can consider five steps for this operation.
1.Division of the gastro-hepatic ligament; identification of the right crus of the diaphragm and posterior vagus nerve.
2.Division of the peritoneum and phreno-esophageal membrane above the esophagus; identification of the left crus of the diaphragm and anterior vagus nerve.
3.Division of the short gastric vessels.
4.Esophageal myotomy.
5.Dor fundoplication.

There were no complications.

There are no conflicts of interest.

Andolfi C, Fisichella PM. Laparoscopic Heller Myotomy and Dor Fundoplication for Esophageal Achalasia: Technique and Perioperative Management. J Laparoendosc Adv Surg Tech A. 2016 Sep 8. [Epub ahead of print]. DOI: 10.1089/lap.2016.0407