Laparoscopic Heller’s Myotomy for Achalasia Cardia by Blunt Dissection: a Safe Technique

Laparoscopic Heller myotomy (LHM) is the “gold standard” surgical treatment for achalasia cardia (AC). Prevailing techniques of LHM have been associated with a high rate (2–33%) of esophageal perforation. The aim of this study is to describe a novel technique of LHM using blunt dissection and to present our initial experience. This study is a retrospective analysis of patients with AC who underwent LHM by a blunt dissection technique (BDT) by a single surgeon from 2011 to 2016. Out of total 35 patients, 22 were males (62.8%) and the mean age was 32 years. None of the patients had endoscopic dilatation and/or other therapeutic procedures before surgery. Median preoperative modified Takita dysphagia grade was 3. The mean lower esophageal sphincter (LES) pressure before surgery was 41.88 mm of Hg. The mean operative time was 72.8 min, and the mean blood loss was 34.5 ml. The median length of postoperative hospital stay was 3 days. No patient required conversion to open surgery and there were no intraoperative and postoperative complications. All patients had sustained symptomatic relief along with significant reduction in dysphagia score. Blunt dissection technique is a safe technique of laparoscopic Hellers’s myotomy in patients with achalasia cardia.