Laparoscopic myotomy and fundoplication for achalasia.

摘要

Heller's 1914 report describes a transabdominal double (anterior and posterior) vertical extramucosal esoph-agomyotomy in a 49-year-old man with a 30-year history of swallowing difficulties. At the time, Heller tucked some omentum into this anterior myotomy with a stitch to maintain separation of the divided muscle. The operation was a success initially; 8 years later, the patient was still improved but was eating slowly. In 1918, De Bruine Groeneveldt described a single anterior myotomy, and Zaaijer is credited with having popularized the single myotomy modification diroughout most of continental Europe. Acceptance of myotomy for treating achalasia in Britain and North America did not come until reports became available on the late complications of cardioplasties. To fhis day, the surgical treatment of achalasia is inspired directly from Heller's contribution, regardless of the surgical approach. Esophageal myotomy for achalasia has been associated with a success rate of 85% to 95%. Controversies regarding the best surgical approach (thoracic or abdominal), the need to add an antireflux procedure, which antireflux procedure, and the extent of the myotomy onto the stomach have been debated for decades.