Laparoscopic Esophageal Surgery in Achalasia

Abstract

Achalasia is a primary esophageal motility disorder of unknown etiology. It is a rare disorder (1/100,000) that affects males and females equally. Achalasia is characterized by progressive loss of peristalsis in the body of the esophagus and failure of a normal or hypertensive lower esophageal sphincter (LES) to relax in response to swallowing.^1,2 No form of therapy returns esophageal peristalsis or LES function to normal. Therapy is aimed instead at relieving the functional obstruction at the gastroesophageal junction. Medical efforts to relieve the distal esophageal obstruction have been largely unsatisfactory. Surgical cardiomyotomy, introduced by Heller in 1913, provides excellent relief of dysphagia in 85–95% of patients with achalasia, with minimal complications.^1–4 Thoracotomy or laparotomy, however, has been required, which results in significant pain and prolonged recovery period. Pressure-controlled balloon dilatation and, more recently, botulinum toxin (Botox) injection of the lower esophageal sphincter have therefore become the primary treatment for achalasia.^5–7 This is in spite of lower success rate, frequent retreatment, and, for pneumatic dilatation, a perforation rate of 3–3-5%.^3,5,7