Laparoscopic Stapled Cardioplasty for End-Stage Achalasia

Introduction: The standard of care for achalasia is laparoscopic Heller's cardiomyotomy. This procedure achieves satisfactory and long-standing results in over 85 % of patients. However, in 10-15 % of patients, esophageal function will progressively deteriorate, and up to 5 % will develop end-stage achalasia. Options in these difficult patients are limited, and include redo cardiomyotomy, repeat dilatation, and in severe cases, esophagectomy. Methods: In this report, we describe an alternate approach, a cardioplasty, which was originally described by Heyrovsky in 1913. Results: The development of an angulated stapling device now makes this operation feasible by a laparoscopic approach. Conclusion: This report highlights our technique for laparoscopic cardioplasty in patients with end-stage achalasia.