This video demonstrate In conclusion, laparoscopic Heller myotomy with Dor fundoplication is effective in relieving dysphagia in most patients with achalasia, preventing simultaneous gastroesophageal reflux. ... Increased esophageal acidity and heartburn in patients after myotomy is attributed to delayed esophageal emptying.

Laparoscopic cardiomyotomy with Dor fundoplication is a highly advanced minimally invasive surgical procedure performed for the treatment of achalasia cardia, a motility disorder in which the lower esophageal sphincter (LES) fails to relax properly, leading to difficulty swallowing, regurgitation, and chest discomfort. With the evolution of minimally invasive surgery, this combined procedure has become the global standard of care due to its excellent functional outcomes and faster recovery. Training and clinical exposure to such procedures at institutions like World Laparoscopy Hospital (WLH) help surgeons develop expertise in advanced gastrointestinal laparoscopic surgery.

Achalasia is characterized by impaired relaxation of the LES and loss of esophageal peristalsis. Historically, open surgery was the standard treatment, but laparoscopic Heller cardiomyotomy combined with an anti-reflux procedure such as Dor fundoplication is now widely considered the preferred approach because it reduces surgical trauma and improves recovery.

The laparoscopic approach involves small keyhole incisions, less postoperative pain, shorter hospital stay, and faster return to normal activities compared to open surgery.

Principle of the Procedure

Laparoscopic Cardiomyotomy:
The procedure involves making a longitudinal incision in the muscle fibers of the lower esophagus and proximal stomach while preserving the mucosal lining. This relieves obstruction and allows smooth passage of food into the stomach.

Dor Fundoplication:
After myotomy, Dor fundoplication is performed by wrapping the anterior fundus of the stomach over the exposed esophageal mucosa (approximately 180–200° wrap). This serves three main purposes:

• Protects the exposed mucosa from acid injury

• Prevents postoperative gastroesophageal reflux

• Provides mechanical support to the myotomy site

Surgical Steps (General Overview)

1. Creation of pneumoperitoneum and port placement

2. Exposure of esophageal hiatus and lower esophagus

3. Careful longitudinal myotomy extending onto gastric cardia

4. Checking mucosal integrity and performing leak test

5. Construction of anterior Dor fundoplication

6. Port closure and recovery protocol

The procedure typically takes around 90–120 minutes depending on patient factors and surgical complexity.

Clinical Outcomes and Effectiveness

Studies have shown excellent symptomatic relief after laparoscopic cardiomyotomy with Dor fundoplication:

• Dysphagia relief in a majority of patients

• Significant reduction in LES pressure and esophageal diameter

• High long-term success rates in early-stage disease

Clinical series also demonstrate marked improvement in symptoms such as dysphagia, regurgitation, chest pain, and epigastric discomfort, with reduced postoperative reflux when Dor fundoplication is added.

Large series studies report dysphagia resolution in nearly 88–90% of patients with very low morbidity and almost zero mortality when performed in experienced centers.

Advantages of Laparoscopic Cardiomyotomy with Dor Fundoplication

• Minimally invasive with small scars

• Short hospital stay (usually 2–3 days)

• Faster recovery and early return to normal diet

• Excellent reflux control when combined with fundoplication

• Gold standard surgical treatment for achalasia

Role of Training at World Laparoscopy Hospital

World Laparoscopy Hospital is known for providing structured hands-on training in advanced laparoscopic gastrointestinal procedures. Training programs typically emphasize:

• Standardized step-wise surgical technique

• Safe tissue handling and precision dissection

• Intracorporeal suturing for fundoplication

• Complication prevention and management

• Evidence-based surgical decision making

Exposure to procedures such as laparoscopic cardiomyotomy with Dor fundoplication helps surgeons gain confidence in treating complex esophageal motility disorders using minimally invasive methods.

Future Perspectives

With advancements in robotic surgery and high-definition visualization, cardiomyotomy procedures are becoming even more precise, allowing better visualization of muscle fibers and reducing mucosal injury risk.

Conclusion

Laparoscopic cardiomyotomy with Dor fundoplication represents a milestone in the management of achalasia cardia. The procedure provides durable symptom relief, effective reflux prevention, and faster patient recovery. With structured training and surgical education, institutions such as World Laparoscopy Hospital contribute significantly to the global advancement of minimally invasive gastrointestinal surgery. Mastery of this procedure ensures better patient outcomes and reflects the evolution of modern laparoscopic surgical practice.