Francisco Schlottmann1,2, Fernando A M Herbella3, Marco G Patti4. 1. Division of Esophageal and Gastric Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon1640, Buenos Aires, Argentina. fschlottmann@hotmail.com. 2. Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. fschlottmann@hotmail.com. 3. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil. 4. Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Abstract
BACKGROUND: Achalasia is a primary esophageal motility disorder characterized by lack of esophageal peristalsis and partial or absent relaxation of the lower esophageal sphincter in response to swallowing. This study aimed to provide an overview of the evolution of the surgical treatment for esophageal achalasia, from the open to the minimally invasive approach. METHODS: Literature review. RESULTS: No curative treatment exists for this disorder. At the beginning of the 20th century, surgical esophagoplasties and cardioplasties were mostly done to treat achalasia. The description of the esophageal myotomy by Heller changed the treatment paradigm and rapidly became the treatment of choice. For many years the esophagomyotomy was done with either an open transthoracic or transabdominal approach. With the advancements of minimally invasive surgery, thoracoscopic and laparoscopic operations became available. The ability to add a fundoplication for the prevention of reflux made the laparoscopic Heller myotomy with partial fundoplication the operation of choice. CONCLUSIONS: Surgical management of esophageal achalasia has significantly evolved in the last century. Currently, minimally invasive Heller myotomy with partial fundoplication is the standard surgical treatment of achalasia.
BACKGROUND: Achalasia is a primary esophageal motility disorder characterized by lack of esophageal peristalsis and partial or absent relaxation of the lower esophageal sphincter in response to swallowing. This study aimed to provide an overview of the evolution of the surgical treatment for esophageal achalasia, from the open to the minimally invasive approach. METHODS: Literature review. RESULTS: No curative treatment exists for this disorder. At the beginning of the 20th century, surgical esophagoplasties and cardioplasties were mostly done to treat achalasia. The description of the esophageal myotomy by Heller changed the treatment paradigm and rapidly became the treatment of choice. For many years the esophagomyotomy was done with either an open transthoracic or transabdominal approach. With the advancements of minimally invasive surgery, thoracoscopic and laparoscopic operations became available. The ability to add a fundoplication for the prevention of reflux made the laparoscopic Heller myotomy with partial fundoplication the operation of choice. CONCLUSIONS: Surgical management of esophageal achalasia has significantly evolved in the last century. Currently, minimally invasive Heller myotomy with partial fundoplication is the standard surgical treatment of achalasia.
Authors: Dimitrios Stefanidis; William Richardson; Timothy M Farrell; Geoffrey P Kohn; Vedra Augenstein; Robert D Fanelli Journal: Surg Endosc Date: 2011-11-02 Impact factor: 4.584
Authors: Henning A Gaissert; Ning Lin; John C Wain; Grant Fankhauser; Cameron D Wright; Douglas J Mathisen Journal: Ann Thorac Surg Date: 2006-06 Impact factor: 4.330