Laparoscopic Myotomy

The treatment of achalasia has undergone a dramatic evolution over the past ten years with the introduction of advanced laparoscopic techniques and the increasing use of the Botulinum toxin. As of this date, achalasia remains a primary esophageal motility disorder of undetermined etiology affecting approximately 0.01 % of the population in the United States . There is currently no available medical or surgical treatment directly targeting the cause of this disease and most standard therapeutic modalities focus on the treatment of the dysphagia secondary to the incomplete relaxation of the lower esophageal sphincter and the loss of esophageal body peristalsis.

The diagnosis of achalasia is currently made by an upper gastro-intestinal series demonstrating the classical Bird’s peak appearance at the level of the gastro-esophageal junction. This should prompt the surgeon to order Manometric studies which will demonstrate a high lower esophageal sphincter [LES] pressure [over 16 to 40 mmHg] and incomplete relaxation with deglutition. Finally, we demand that all  patients undergo a pre-operative UGI endoscopy by an experienced gastro-enterologist.

Prior to being referred to a surgical office for surgical intervention, most patients have undergone either pneumatic dilatations or endoluminal injections of Botulimun Toxin. For patients, initally seen in our office, we usually only recommend one endoluminal endoscopic injection of Butulinum Toxin. Most patients will be instructed that they will experience a window of symptom relief which will last between 6 to 18 months on the average. We increasingly recommend that patients undergo a laparoscopic Heller Myotomy as a primary, initial therapeutic modality. A Laparoscopic Heller Myotomy remains the most effective treatment for achalasia.