Laparoscopy combined with esophagogastroscopy in the minimally invasive treatment of achalasia of cardia: an analysis of 26 cases        ZHAO Hong-zhi, QIN Ming-fang, WANG Qing, et al. Center of Tianjin Minimally Invasive Surgery, Nankai Hospital, Tianjin 300100，China
Corresponding author: ZHAO Hong-zhi, E-mail: tjzhhzh@sina.com
Abstract    Objective    To investigate the feasibility and clinical value of laparoscopy combined with esophagogastroscopy in the minimally invasive treatment of achalasia of cardia. Methods    From December 2005 to March 2009, 26 patients with achalasia of cardia were performed combined laparoscopic and esophagogastroscopic surgery at Nankai Hospital of Tianjin. The combined surgery comprised of laparoscopic Heller myotomy with Dor fundoplication and intraoperative gastroscopic guidance and examination. Perioperative clinical outcome data of all patients were collected and analyzed prospectively. Results    All laparoscopic surgeries were accomplished successfully. No conversion to open surgery or severe complications were noted in the study. Perforation of esophageal mucosa occurred in 1 patient，which discovered by esophagogastroscopy during laparoscopic operation. The patient was received laparoscopic neoplasty immediately. With postoperative follow-up of 4 to 42 months, none of the patients appeared dysphagia or vomiting. There was one patient who appeared mild regurgitation and chest pain in the first year after operation. After 3 months of operation，postoperative assessment consisted of endoscopic, radiologic, manometric and pH metric studies showed a satisfactory result. Conclusion    Laparoscopy operation should be the feasible procedure to treat the typical esophagic achalasia with the advantages of little trauma, quick recovery and reliable effect. Combined with intraoperative gastroscopic guidance and examination, it can improve the security and decrease the complication during laparoscopy operation.