Surgical Management of Achalasia: Thoracoscopic Myotomy

Abstract

Achalasia is an esophageal motility disorder that results in clinically significant dysphagia. The esophageal manometry findings are characterized by aperistalsis in the body of the esophagus and incomplete relaxation in the lower esophageal sphincter during swallowing. The etiology of achalasia is unknown, and the current therapeutic interventions target the underlying pathophysiology of the disease. Endoscopic therapies, such as pneumatic balloon dilation and botulinum toxin injection, typically only produce temporary improvement of dysphagia symptoms. The cornerstone of surgical therapy for achalasia is esophagomyotomy. The video-assisted thoracoscopic approach for esophagomyotomy was described by Pellegrini in 1992. Thoracoscopic myotomy is an effective alternative to laparoscopic myotomy for the surgical management of achalasia. The thoracoscopic myotomy has demonstrated comparable results to laparoscopic myotomy for clinical relief of dysphagia and minimal postoperative complications.