Surgical treatment of achalasia: current status and controversies.
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.
Abir
Farshad
F
Department of Surgery, Yale University School of Medicine, New Haven, Conn. 06520-8062, USA.
Modlin
Irvin
I
Kidd
Mark
M
Bell
Robert
R
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002404:Catheterization; D013505:Digestive System Surgical Procedures; D034462:Dissent and Disputes; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D004947:Esophagus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D013906:Thoracoscopy
D019274:Botulinum Toxins, Type A