Laparoscopic Heller Myotomy and Dor Fundoplication for the Patient Suffering from Achalasia
Laparoscopic Heller myotomy is a minimally invasive procedure that opens the tight lower esophageal sphincter by performing a myotomy of the thick muscle of the lower part of the esophagus and the upper part of the stomach to relieve the dysphagia.
After Laparoscopic Hellers Myotomy a Dor fundoplication is performed around the esophagus to make a low-pressure valve. This is performed to prevent reflux from the stomach into the esophagus following the myotomy.
There is a very small chance that patients may develop reflux despite Dor fundoplication and may need to be treated with antacid medication. This procedure results in great symptomatic relief.
After Laparoscopic Heller myotomy patients usually stay in the hospital for one night. They start drinking one day after surgery and are discharged home. They will follow dietary restrictions for about two weeks and can start advancing their diet after a clinic visit two weeks following the surgery.
Laparoscopic Heller myotomy and Dor fundoplication improve swallowing in more than 90% of patients. The causes of the few failures are still not completely understood. To identify the technical elements that affected the outcomes.
In the above video, The myotomy was planned to be 7 cm long, extending 1 to 2 cm onto the gastric wall. After completing the myotomy, the short gastric vessels were divided, and an anterior 180° Dor fundoplication was created using 2 parallel rows of sutures. According to the plan, only the uppermost stitch of these rows was meant to include the crural pillar, in addition to the stomach and esophageal muscle.
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