Laparoscopic Heller myotomy and fundoplication in patients with end-stage achalasia.

Achalasia may present in a non-advanced or advanced (end stage) stage. The latter is characterized by massive esophageal dilatation and/or the loss of the esophageal straight axis (sigmoid-shaped esophagus). The treatment for non-advanced cases of achalasia is well defined while the therapy for end-stage disease is still debatable. Laparoscopic Heller's myotomy is an option in patients with end-stage achalasia. Dysphagia is relieved in a significant number of patients, it is a simpler operation to be used in frail patients, and it does not preclude a latter esophagectomy if necessary.