[Achalasia of the oesophagus. Operative treatment by abdominal myotomy and fundoplication (author's transl)].

Achalasia is a neuromuscular functional disturbance with dystonia and dyscinesia of the entire tubular oesophagus of unknown aetiology characterised by loss of cardial opening reflex. In the usual functional state dysphagia and moderate stenosis are observed, but occasionally an organic form with marked mega-dolicho-oesophagus will develop. Therapeutically an attempt is made to reduce the hypertonus of the terminal oesophagus. In mild or moderate cases this may be achieved by dilatation alone. If conservative treatment fails or in severe forms an operative correction is mandatory, we advise preoperative dilatation together with an extramucous myotomy of the distal anterior oesophageal wall and a fundoplication to prevent the gastro-oesophageal reflux. This abdominal procedure demands great care but is not traumatising and ensures satisfactory early and late results even in patients with considerable surgical risks. Operative indication and technique in 63 cases are demonstrated.