Surgical Treatment of Achalasia

ABSTRACT

Achalasia is a rare motility disorder of the esophagus characterized by the absence of peristalsis of the esophageal body and failure of relaxation of the lower esophageal sphincter, which is caused by loss of ganglionic cells of myenteric plexus. Medical therapy is usually ineffective and pneumatic dilation and esophagocardiomyotomy are known to be the treatment of choice. In the past, pneumatic dilation was preferred because of the invasiveness of myotomy even though, the posttreatment outcome was better in myotomy than in pneumatic dilation. However, after introduction of minimally invasive surgery for myotomy, such preference is moving towards myotomy. In this article, current trends of minimally invasive surgery in the treatment of achalasia and the surgical outcome of minimally invasive myotomy in comparison with that of pneumatic dilation are reviewed.