Published: 2022-10-29

Surgical management of achalasia cardia-analysis of immediate outcomes

Raj Nihedan K. G., Sastha Ahanadha Pillai, Karthikeyan Srinivasan, Padmanabhan Subbareddiar, Dhinesh Kumar M.


Achalasia cardia is a motility disorder characterised by failure of relaxation of the lower oesophageal sphincter (LES) and associated with lack of peristalsis in the body of oesophagus. The mainstay of treatment in achalasia cardia is to reduce the LES pressure and improve oesophageal emptying by gravity. LHM is still considered the gold standard against which other methods are compared. The records of all patients who underwent surgery for achalasia cardia between August 2018 and December 2021 in the department of Surgical Gastroenterology, Government Rajaji Hospital and Madurai Medical College, Madurai, Tamil Nadu, India were reviewed retrospectively. Eighteen patients underwent surgery for achalasia cardia with median age of 32.5 years and the median duration of symptoms was 30 months. Seven patients had undergone pneumatic dilatation previously. Two patients who had mucosal injury had undergone pneumatic dilatation previously. The duration of surgery was significantly higher for the patients who underwent previous pneumatic dilatation when compared to those who did not undergo dilatation (200 minutes vs 170 minutes). The Eckardt score was zero in 12 patients in follow-up. One patient had a score of 1 and five patients had a score of 2. Laparoscopic Heller myotomy is the most effective current surgical management for achalasia cardia. It can be safely performed even in patients with prior pneumatic dilatations with lesser reintervention rates.


LES, Laparoscopic Heller myotomy, Mucosal injury, Eckardt score

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