AN EXPERIENCE OF LAPAROSCOPIC MODIFIED HELLER CARDIOMYOTOMY FOR ACHALASIA CARDIA.

Objective: The study was carried out to ascertain the outcome of laparoscopic modified Heller's myotomy for achalasia cardia and to determine the morbidity associated with it. Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was conducted in Combined Military Hospital (CMH) Rawalpindi over a period of 4 years, from Jan 2010 to Aug 2014. Material and Methods: This study was carried out on patients undergoing surgical repair of laparoscopic Heller myotomy for cardiac achalasia at Combined Military Hospital Rawalpindi over a period of four years (2010-2014). Patients undergoing laparoscopic-modified Heller myotomy at a thoracic referral and surgical training center. Eighteen cases of achalasia cardia based on clinical, barium and endoscopic findings were included in the sample using non probability purposive sampling technique. Pseudo achalasia, sigmoid esophagus were excluded. Laparoscopic modified Heller myotomy was done in all patients. Data were analyzed with the help of SPSS 20.0. Results: Age ranged between 14 years to 40 years with mean age of 28 years. The most frequent symptom was dysphagia (95%), followed by regurgitation of ingested food (60%), weight loss (40%) and chest pain (20%). Mean operating time was forty minutes. There was no perioperative mortality. We applied Dor patch in 4 patients. Three patients had mucosal tear on large myotomy, diagnosed per operatively and repaired. There was no conversion to open procedure. There was marked improvement in symptoms especially dysphagia and there was no post operative reflux. Conclusion: Modified Heller myotomy by laparoscopic approach is a safe and effective procedure with acceptable results. It is easy to perform and improves the symptoms of the suffering individual. [ABSTRACT FROM AUTHOR]