Conventional Cardiomyotomy in Achalasia

Abstract

Achalasia is characterized manometrically by an incomplete relaxation of the lower esophageal sphincter. This “outflow obstruction” results in a motility disorder of the tubulary esophagus, in most cases aperistalsis. However, an appearance as seen in diffuse esophageal spasm can also occur. Medical therapy shows short-term benefit but no long-term solution. Endoscopic dilatation has been established as primary therapy. However usually repetitive dilatations even in short intervals are necessary. In comparison to surgery dilatation is a less controllable procedure. The risk of perforation is always given, especially in cases of recurrent application. Surgical therapy on the other hand provides the opportunity for a controlled myotomy followed by an antireflux procedure with a high rate of permanent success. Recent publications support an early surgical approach because cure can be provided and a partial remission of the motility disorder can be noticed.