Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy.

Background: The development of minimally invasive surgery has renewed interest in the surgical therapy of achalasia.

Methods: 21 patients with esophageal achalasia underwent Heller's laparoscopic myotomy with anterior fundoplication between August 1991 and March 1996.

Results: There were two intraoperative perforations of the mucosa sutured laparoscopically with no postoperative sequelae; both complications occurred in patients previously treated with pneumatic dilatation; no perforations occurred in the 14 patients who had not been submitted to pneumatic dilatation (28% vs 0%). There were no surgical mortalities and no postoperative morbidities. Complete relief of dysphagia and modifications of radiological and manometric patterns were achieved in all patients. All patients remain asymptomatic at follow-ups ranging from 3 to 55 months after surgery.

Conclusions: Laparoscopic Heller's myotomy is as effective as traditional surgery in treating symptoms and has all the advantages of pneumatic dilatation in terms of short hospital stay, quick recovery, and low cost; preoperative pneumatic dilatation is a risk factor for intraoperative mucosal perforation.