The treatment of achalasia has remained controversial with most of the debate relating to the choice between balloon dilatation of the cardia on the one hand, and surgical myotomy on the other.
The reason for this disagreement is that surgical treatment is more invasive than balloon dilatation, but entails the widen operation field. Laparoscopic treatment is a minimally invasive surgery and this procedure makes possible to perform surgical treatment except a major incision.
Laparoscopic treatment was performed in 4 cases of esophageal achalasia. Our standard procedure is Girard's method modified by T. Tanaka, performed in over 80 cases of achalasia in open surgery.
The results have been good. This method consists of a longmyotomy for releasing disturbances in the passage, transverse sutures for withholding restenosis with antireflex, and fundopexy for antireflex. The indications for laparoscopic treatment are a patient who has spindle type or flask type with grade 1, 2 of achalasia, except with a history of surgical operations in the upper abdomen and balloon dilatation.
The procedure is as follows. The patient was put under general anesthesia, and a lithotomy position was made. Five trocars were placed in the abdomen and an initial dissection exposing the esophagus was made by electrocautery or harmonic scalpel. The esophagus was retracted downward by miniretract (Autosuture Inc.). Finally about 12 cm of the esophagus and the cardia of stomach were freed by gentle dissection around the esophagus. The vagal nerves were confirmed and preserved.
About 10 cm of longmyotomy was performed by J-Hook and a muscle specimen for pathological diagnosis was collected. Next, 2-3 transverse sutures (sutured edges of myotomy and serosa of the cardia) were made on each side, and then the fundus was sutured with a left-side hiatus of the diaphlagm followed by a fundopexy. As a result, there was no difference between the open procedure and the laparoscopic procedure in terms of complaints, esophagram, or manometric study of esophagus.