Laparoscopic Heller Myotomy and DOR Fundoplication Following Unsuccessful Balloon Dilation
Case description
Laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed achalasia. The best place to start the myotomy is about 2 cm above the gastroesophageal junction, where the submucosal plane is easier to find. Essential to the operation is the length of the myotomy. Some recommendations advocate for 4 to 8 cm proximal and 0.5 to 2 cm distal myotomy, which have been associated to lower dysphagia rates and LES resting pressures. Oelschlager et al. have shown that when the distal myotomy in the stomach is increased to 3 cm, both dysphagia rates and LES resting pressures are further reduced, with no associated increase in pyrosis, regurgitation, or thoracic pain.
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