Surgical treatment of achalasia: current status and controversies.

Abstract:

OBJECTIVE:To review the current management of achalasia, and the controversies regarding the different treatment options. METHODS:A review of the literature was performed. The key words used were esophageal achalasia, Heller myotomy, endoscopic balloon dilatation, laparoscopic Heller myotomy, and fundoplication. RESULTS:Patients who fail medical therapy (e.g. pharmacologic therapy, botulinum toxin, balloon dilatation) should be considered for surgical therapy for the management of achalasia. Currently, numerous surgical procedures exist for the treatment of achalasia (transabdominal cardiomyotomy, thoracoscopic or open transthoracic cardiomyotomy, and laparoscopic Heller myotomy with an antireflux procedure). CONCLUSIONS:Laparoscopic Heller myotomy is generally accepted as the operative procedure of choice for achalasia. However, controversy exists as to whether a concomitant antireflux procedure is necessary, and if so, what type should be performed. Given the deleterious effects of postoperative reflux, and the facility of including an antireflux procedure at the time of the myotomy, there is merit in undertaking an antireflux procedure at the time of the laparoscopic Heller myotomy.

journal_name

Dig Surg

journal_title

Digestive surgery

authors

Abir F,Modlin I,Kidd M,Bell R

doi

10.1159/000079341

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

165-76

issue

3

eissn

0253-4886

issn

1421-9883

pii

79341

journal_volume

21

pub_type

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