Laparoscopic Surgery for Achalacia Cardial

Achalasia cardia or achalasia is an uncommon disorder that causes difficulty in swallowing. Although the condition cannot be cured, the aim of the treatment is relief of symptoms.

The commonest symptom of achalasia is difficulty in swallowing. Patients get a sensation that swallowed food as well as liquids get stuck in the chest. This problem invariably progresses and becomes severe. Other symptoms include regurgitation of swallowed food and liquid, chest pain, heartburn, a sensation of fullness or a lump in the throat, hiccups, and weight loss.

The doctors can suspect achalasia based on the symptoms and order certain tests to confirm the diagnosis.

The surgery performed to treat patients with achalasia is called cardiomyotomy (division of the muscles of the LES and upper end of stomach). In the past this surgery was performed through a large open incision in the upper abdomen. Today, it is carried out laparoscopically.

This operation is performed under general anaesthesia. The surgeon makes a small (1cm) incision in the upper abdomen and introduces a cannula or a tube inside the abdomen. He then inserts a telescope attached to a miniature video camera through the cannula that gives him and the operating team a magnified view of your internal organs on a video monitor. He will then place four other additional cannulas through tiny (5mm) cuts to accommodate special long instruments. At the surgery, the LES and the muscle layer in the upper part of the stomach are divided precisely under the magnified view. As division of LES makes the patient prone to gastro-esophageal reflux, the upper part of the stomach called fundus is rotated around and fixed in such a way that it creates a fundoplication or a valve. This prevents the acid from the stomach from coming back into the esophagus.

Per Oral Endoscopic Myotomy (POEM)): This is a newly developed endoscopic procedure for treatment of achalasia cardia. The procedure is performed under general anaesthesia. An endoscope is passed into the esophagus and an incision is made in the lining (mucosa) of the esophagus.