Surgical Management of Achalasia: Thoracoscopic Myotomy

  • Robert E. MerrittEmail author


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.


Achalasia Myotomy Video-assisted thoracic surgery 


  1. 1.
    Ellis FH Jr, Kiser JC, Schlegel JF, et al. Esophagomyotomy for esophageal achalasia: experimental, clinical, and manometric aspects. Ann Surg. 1967;166:640–56.CrossRefGoogle Scholar
  2. 2.
    Pellegrini C, Wetter LA, Patti M, Leichter R, et al. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg. 1992;216:291–6.CrossRefGoogle Scholar
  3. 3.
    Kesler KA, Tarvin SE, Brooks JA, et al. Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique. Ann Thorac Surg. 2004;77:385–92.CrossRefGoogle Scholar
  4. 4.
    Agrawal D, Meekison L, Walker WS. Long-term clinical results of thoracoscopic Heller’s myotomy in the treatment of achalasia. Eur J Cardiothoracic Surg. 2008;34:423–6.CrossRefGoogle Scholar
  5. 5.
    Cade R. Heller’s myotomy: thoracoscopic or laparoscopic. Dis Esophagus. 2000;13:279–81.CrossRefGoogle Scholar
  6. 6.
    Patti MG, Arcerito M, De Pinto M, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. 1998;2:561–6.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.The Division of Thoracic Surgery, Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA

Personalised recommendations