[Laparoscopic surgery for esophageal achalasia].

Laparoscopic Heller myotomy and Dor fundoplication (LHD) were superior to pneumatic dilatation in terms of the treatment of esophageal achalasia according to 2 prospective randomized studies. Therefore, LHD is recommended. Some key points should be considered when performing LHD. First, the short gastric arteries and veins should be carefully divided so as not to injure the spleen. Second, during the Heller myotomy, the mucosa of the esophagus and stomach should not be injured because an inappropriate myotomy will not alleviate dysphagia, and intensive myotomy is recommended with care. When the mucosa is injured, the surgeon should repair the mucosa using absorbable sutures and the intracorporeal knot tying technique. Third, a tight fundoplication can cause dysphagia postoperatively. The endoscope should be inserted into the stomach and the fundoplication should be performed loosely.