[Recent advances in the surgical management of esophageal achalasia: modified Girard method and laparoscopic approach].

The standard surgical treatment for esophageal achalasia consists of contraction of the lower esophageal sphincter combined with antireflux repair. This paper describes the techniques of the modified Girard method with a laparoscopic approach. The modified Girard method consists of a long esophagomyotomy, the placement of horizontal transverse sutures to prevent restricture due to reflex, and fundopexy for antireflex repair. We have recently used a laparoscopic approach with the modified Girard method in 10 patients with esophageal achalasia. A total of five trocars were required for the long myotomy in the lower esophagus and repair of the esophagogastric junction. A myotomy of approximately 10-12 cm was made along the lower esophagus and cardia lesion using an electric J-hook. Than transverse sutures were placed on each side of the lower myotomy and the gastric fundus was covered with the upper myotomy with several sutures to diaphlagm and each side of the myotomy lene. Excellent results were achieved, and the patients recovered from surgery more quickly compared with those undergoing an open procedure. However, postoperative manometric findings did not differ between patients who underwent the laparoscopic and open procedures.