Surgical Endoscopy

, Volume 26, Issue 2, pp 296–311 | Cite as

SAGES guidelines for the surgical treatment of esophageal achalasia

  • Dimitrios Stefanidis
  • William Richardson
  • Timothy M. Farrell
  • Geoffrey P. Kohn
  • Vedra Augenstein
  • Robert D. Fanelli


The guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth.


Clinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the...


Botulinum Toxin Achalasia Lower Esophageal Sphincter Lower Esophageal Sphincter Pressure Botulinum Toxin Injection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Drs. Stefanidis, Richardson, Farrell, Kohn, Augenstein, and Fanelli have no conflicts of interest or financial ties relevant to this publication to disclose.


  1. 1.
    Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schunemann HJ (2008) Going from evidence to recommendations. BMJ 336:1049–1051PubMedCrossRefGoogle Scholar
  2. 2.
    Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926PubMedCrossRefGoogle Scholar
  3. 3.
    Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57PubMedCrossRefGoogle Scholar
  4. 4.
    Goldblum JR, Rice TW, Richter JE (1996) Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 111:648–654PubMedCrossRefGoogle Scholar
  5. 5.
    Woltman TA, Pellegrini CA, Oelschlager BK (2005) Achalasia. Surg Clin North Am 85:483–493PubMedCrossRefGoogle Scholar
  6. 6.
    Vaezi MF, Richter JE (1999) Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol 94:3406–3412PubMedCrossRefGoogle Scholar
  7. 7.
    Eckardt AJ, Eckardt VF (2009) Current clinical approach to achalasia. World J Gastroenterol 15:3969–3975PubMedCrossRefGoogle Scholar
  8. 8.
    Wen ZH, Gardener E, Wang YP (2004) Nitrates for achalasia. Cochrane Database Syst Rev CD002299Google Scholar
  9. 9.
    Bassotti G, Annese V (1999) Review article: pharmacological options in achalasia. Aliment Pharmacol Ther 13:1391–1396PubMedCrossRefGoogle Scholar
  10. 10.
    Short TP, Thomas E (1992) An overview of the role of calcium antagonists in the treatment of achalasia and diffuse oesophageal spasm. Drugs 43:177–184PubMedCrossRefGoogle Scholar
  11. 11.
    Annese V, Bassotti G (2006) Non-surgical treatment of esophageal achalasia. World J Gastroenterol 12:5763–5766PubMedGoogle Scholar
  12. 12.
    Storr M, Born P, Frimberger E, Weigert N, Rosch T, Meining A, Classen M, Allescher HD (2002) Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment. BMC Gastroenterol 2:19PubMedCrossRefGoogle Scholar
  13. 13.
    Martinek J, Siroky M, Plottova Z, Bures J, Hep A, Spicak J (2003) Treatment of patients with achalasia with botulinum toxin: a multicenter prospective cohort study. Dis Esophagus 16:204–209PubMedCrossRefGoogle Scholar
  14. 14.
    Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN (1996) Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology 110:1410–1415PubMedCrossRefGoogle Scholar
  15. 15.
    Allescher HD, Storr M, Seige M, Gonzales-Donoso R, Ott R, Born P, Frimberger E, Weigert N, Stier A, Kurjak M, Rosch T, Classen M (2001) Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A prospective study with long-term follow-Up. Endoscopy 33:1007–1017PubMedCrossRefGoogle Scholar
  16. 16.
    Annese V, Bassotti G, Coccia G, Dinelli M, D’Onofrio V, Gatto G, Leandro G, Repici A, Testoni PA, Andriulli A (2000) A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 46:597–600PubMedCrossRefGoogle Scholar
  17. 17.
    Bassotti G, D’Onofrio V, Battaglia E, Fiorella S, Dughera L, Iaquinto G, Mazzocchi A, Morelli A, Annese V (2006) Treatment with botulinum toxin of octo-nonagerians with oesophageal achalasia: a two-year follow-up study. Aliment Pharmacol Ther 23:1615–1619PubMedCrossRefGoogle Scholar
  18. 18.
    Hashemi N, Banwait KS, DiMarino AJ, Cohen S (2005) Manometric evaluation of achalasia in the elderly. Aliment Pharmacol Ther 21:431–434PubMedCrossRefGoogle Scholar
  19. 19.
    Neubrand M, Scheurlen C, Schepke M, Sauerbruch T (2002) Long-term results and prognostic factors in the treatment of achalasia with botulinum toxin. Endoscopy 34:519–523PubMedCrossRefGoogle Scholar
  20. 20.
    Kolbasnik J, Waterfall WE, Fachnie B, Chen Y, Tougas G (1999) Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol 94:3434–3439PubMedCrossRefGoogle Scholar
  21. 21.
    Mac Iver R, Liptay M, Johnson Y (2007) A case of mediastinitis following botulinum toxin type A treatment for achalasia. Nat Clin Pract Gastroenterol Hepatol 4:579–582PubMedGoogle Scholar
  22. 22.
    Malnick SD, Metchnik L, Somin M, Bergman N, Attali M (2000) Fatal heart block following treatment with botulinum toxin for achalasia. Am J Gastroenterol 95:3333–3334PubMedCrossRefGoogle Scholar
  23. 23.
    Leyden JE, Moss AC, MacMathuna P (2006) Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev CD005046Google Scholar
  24. 24.
    Wang L, Li YM, Li L, Yu CH (2008) A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol 14:5900–5906PubMedCrossRefGoogle Scholar
  25. 25.
    Annese V, Bassotti G, Coccia G, D’Onofrio V, Gatto G, Repici A, Andriulli A (1999) Comparison of two different formulations of botulinum toxin A for the treatment of oesophageal achalasia. The Gismad Achalasia Study Group. Aliment Pharmacol Ther 13:1347–1350PubMedCrossRefGoogle Scholar
  26. 26.
    Pohl D, Tutuian R (2007) Achalasia: an overview of diagnosis and treatment. J Gastrointest Liver Dis 16:297–303Google Scholar
  27. 27.
    Kadakia SC, Wong RK (2001) Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am 11:325–346 viiPubMedGoogle Scholar
  28. 28.
    Chuah SK, Hu TH, Wu KL, Kuo CM, Fong TV, Lee CM, Changchien CS (2008) Endoscope-guided pneumatic dilatation of esophageal achalasia without fluoroscopy is another safe and effective treatment option: a report of Taiwan. Surg Laparosc Endosc Percutan Tech 18:8–12PubMedCrossRefGoogle Scholar
  29. 29.
    Eckardt VF, Gockel I, Bernhard G (2004) Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 53:629–633PubMedCrossRefGoogle Scholar
  30. 30.
    Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Zavos C, Papaziogas B, Mimidis K (2005) Long-term results of pneumatic dilation for achalasia: a 15 years’ experience. World J Gastroenterol 11:5701–5705PubMedGoogle Scholar
  31. 31.
    West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE (2002) Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol 97:1346–1351PubMedCrossRefGoogle Scholar
  32. 32.
    Zerbib F, Thetiot V, Richy F, Benajah DA, Message L, Lamouliatte H (2006) Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia. Am J Gastroenterol 101:692–697PubMedCrossRefGoogle Scholar
  33. 33.
    Gockel I, Junginger T, Bernhard G, Eckardt VF (2004) Heller myotomy for failed pneumatic dilation in achalasia: How effective is it? Ann Surg 239:371–377PubMedCrossRefGoogle Scholar
  34. 34.
    Farhoomand K, Connor JT, Richter JE, Achkar E, Vaezi MF (2004) Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2:389–394PubMedCrossRefGoogle Scholar
  35. 35.
    Dagli U, Kuran S, Savas N, Ozin Y, Alkim C, Atalay F, Sahin B (2009) Factors predicting outcome of balloon dilatation in achalasia. Dig Dis Sci 54:1237–1242PubMedCrossRefGoogle Scholar
  36. 36.
    Leeuwenburgh I, Van Dekken H, Scholten P, Hansen BE, Haringsma J, Siersema PD, Kuipers EJ (2006) Oesophagitis is common in patients with achalasia after pneumatic dilatation. Aliment Pharmacol Ther 23:1197–1203PubMedCrossRefGoogle Scholar
  37. 37.
    Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, Baker ME, Rice TW (2006) The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol 4:580–587PubMedCrossRefGoogle Scholar
  38. 38.
    Mikaeli J, Bishehsari F, Montazeri G, Mahdavinia M, Yaghoobi M, Darvish-Moghadam S, Farrokhi F, Shirani S, Estakhri A, Malekzadeh R (2006) Injection of botulinum toxin before pneumatic dilatation in achalasia treatment: a randomized-controlled trial. Aliment Pharmacol Ther 24:983–989PubMedCrossRefGoogle Scholar
  39. 39.
    Mukherjee S, Kaplan DS, Parasher G, Sipple MS (2000) Expandable metal stents in achalasia—Is there a role? Am J Gastroenterol 95:2185–2188PubMedGoogle Scholar
  40. 40.
    Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ (2003) Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up. World J Gastroenterol 9:2370–2373PubMedGoogle Scholar
  41. 41.
    Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271PubMedCrossRefGoogle Scholar
  42. 42.
    Kuster GG (1998) Local epinephrine facilitates laparoscopic Heller myotomy. Surg Endosc 12:79–81PubMedCrossRefGoogle Scholar
  43. 43.
    Endo S, Nakajima K, Nishikawa K, Takahashi T, Souma Y, Taniguchi E, Ito T, Nishida T (2009) Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes. Dig Surg 26:342–348PubMedCrossRefGoogle Scholar
  44. 44.
    Jeansonne LO, White BC, Pilger KE, Shane MD, Zagorski S, Davis SS, Hunter JG, Lin E, Smith CD (2007) Ten-year follow-up of laparoscopic Heller myotomy for achalasia shows durability. Surg Endosc 21:1498–1502PubMedCrossRefGoogle Scholar
  45. 45.
    Csendes A, Braghetto I, Henriquez A, Cortes C (1989) Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 30:299–304PubMedCrossRefGoogle Scholar
  46. 46.
    Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henriquez A (2006) Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 243:196–203PubMedCrossRefGoogle Scholar
  47. 47.
    Tsiaoussis J, Athanasakis E, Pechlivanides G, Tzortzinis A, Gouvas N, Mantides A, Xynos E (2007) Long-term functional results after laparoscopic surgery for esophageal achalasia. Am J Surg 193:26–31PubMedCrossRefGoogle Scholar
  48. 48.
    Rakita S, Bloomston M, Villadolid D, Thometz D, Boe B, Rosemurgy A (2005) Age affects presenting symptoms of achalasia and outcomes after myotomy. Am Surg 71:424–429PubMedGoogle Scholar
  49. 49.
    Bessell JR, Lally CJ, Schloithe A, Jamieson GG, Devitt PG, Watson DI (2006) Laparoscopic cardiomyotomy for achalasia: long-term outcomes. ANZ J Surg 76:558–562PubMedCrossRefGoogle Scholar
  50. 50.
    Wang L, Li YM, Li L (2009) Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci 54:2303–2311PubMedCrossRefGoogle Scholar
  51. 51.
    Ferulano GP, Dilillo S, D’Ambra M, Lionetti R, Saviano C, Fico D (2005) Oesophageal achalasia in elderly people: results of the laparoscopic Heller-Dor myotomy. Acta Biomed 76(Suppl 1):37–41PubMedGoogle Scholar
  52. 52.
    Yamamura MS, Gilster JC, Myers BS, Deveney CW, Sheppard BC (2000) Laparoscopic Heller myotomy and anterior fundoplication for achalasia results in a high degree of patient satisfaction. Arch Surg 135:902–906PubMedCrossRefGoogle Scholar
  53. 53.
    Ben-Meir A, Urbach DR, Khajanchee YS, Hansen PD, Swanstrom LL (2001) Quality of life before and after laparoscopic Heller myotomy for achalasia. Am J Surg 181:471–474PubMedCrossRefGoogle Scholar
  54. 54.
    Mineo TC, Ambrogi V (2004) Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon’s experience. Eur J Cardiothorac Surg 25:1089–1096PubMedCrossRefGoogle Scholar
  55. 55.
    Eckardt VF, Stauf B, Bernhard G (1999) Chest pain in achalasia: patient characteristics and clinical course. Gastroenterology 116:1300–1304PubMedCrossRefGoogle Scholar
  56. 56.
    Smith CD, Stival A, Howell DL, Swafford V (2006) Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg 243:579–584; discussion 584–576PubMedCrossRefGoogle Scholar
  57. 57.
    Deb S, Deschamps C, Allen MS, Nichols FC 3rd, Cassivi SD, Crownhart BS, Pairolero PC (2005) Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg 80:1191–1194; discussion 1194–1195PubMedCrossRefGoogle Scholar
  58. 58.
    Beckingham IJ, Callanan M, Louw JA, Bornman PC (1999) Laparoscopic cardiomyotomy for achalasia after failed balloon dilatation. Surg Endosc 13:493–496PubMedCrossRefGoogle Scholar
  59. 59.
    Morino M, Rebecchi F, Festa V, Garrone C (1997) Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc 11:359–361PubMedCrossRefGoogle Scholar
  60. 60.
    Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J (1971) Treatment of achalasia with pneumatic dilatations. Gut 12:268–275PubMedCrossRefGoogle Scholar
  61. 61.
    Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, Gantert W, Way LW (1999) Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci 44:2270–2276PubMedCrossRefGoogle Scholar
  62. 62.
    Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, Johnson M, Boyce W (2005) Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after Botox or dilation. Ann Surg 241:725–733; discussion 733–725PubMedCrossRefGoogle Scholar
  63. 63.
    Horgan S, Pellegrini CA (1999) Botulinum toxin injections for achalasia symptoms. Am J Gastroenterol 94:300–301PubMedCrossRefGoogle Scholar
  64. 64.
    Fishman VM, Parkman HP, Schiano TD, Hills C, Dabezies MA, Cohen S, Fisher RS, Miller LS (1996) Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 91:1724–1730PubMedGoogle Scholar
  65. 65.
    Horgan S, Hudda K, Eubanks T, McAllister J, Pellegrini CA (1999) Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc 13:576–579PubMedCrossRefGoogle Scholar
  66. 66.
    Bonavina L, Incarbone R, Antoniazzi L, Reitano M, Peracchia A (1999) Previous endoscopic treatment does not affect complication rate and outcome of laparoscopic Heller myotomy and anterior fundoplication for oesophageal achalasia. Ital J Gastroenterol Hepatol 31:827–830PubMedGoogle Scholar
  67. 67.
    Peracchia A, Bonavina L (2000) Achalasia: dilation, injection or surgery? Can J Gastroenterol 14:441–443PubMedGoogle Scholar
  68. 68.
    Kostic S, Kjellin A, Ruth M, Lonroth H, Johnsson E, Andersson M, Lundell L (2007) Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 31:470–478PubMedCrossRefGoogle Scholar
  69. 69.
    Lopushinsky SR, Urbach DR (2006) Pneumatic dilatation and surgical myotomy for achalasia. JAMA 296:2227–2233PubMedCrossRefGoogle Scholar
  70. 70.
    Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, Gatto G, D’Onofrio V, Benini L, Contini S, Molena D, Battaglia G, Tardio B, Andriulli A, Ancona E (2004) Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg 239:364–370PubMedCrossRefGoogle Scholar
  71. 71.
    Urbach DR, Hansen PD, Khajanchee YS, Swanstrom LL (2001) A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg 5:192–205PubMedCrossRefGoogle Scholar
  72. 72.
    Douard R, Gaudric M, Chaussade S, Couturier D, Houssin D, Dousset B (2004) Functional results after laparoscopic Heller myotomy for achalasia: a comparative study to open surgery. Surgery 136:16–24PubMedCrossRefGoogle Scholar
  73. 73.
    Crema E, Benelli AG, Silva AV, Martins AJ, Pastore R, Kujavao GH, Silva AA, Santana JR (2005) Assessment of pulmonary function in patients before and after laparoscopic and open esophagogastric surgery. Surg Endosc 19:133–136PubMedCrossRefGoogle Scholar
  74. 74.
    Collard JM, Romagnoli R, Lengele B, Salizzoni M, Kestens PJ (1996) Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery. Acta Chir Belg 96:62–65PubMedGoogle Scholar
  75. 75.
    Dempsey DT, Kalan MM, Gerson RS, Parkman HP, Maier WP (1999) Comparison of outcomes following open and laparoscopic esophagomyotomy for achalasia. Surg Endosc 13:747–750PubMedCrossRefGoogle Scholar
  76. 76.
    Katilius M, Velanovich V (2001) Heller myotomy for achalasia: quality of life comparison of laparoscopic and open approaches. JSLS 5:227–231PubMedGoogle Scholar
  77. 77.
    Torquati A, Richards WO, Holzman MD, Sharp KW (2006) Laparoscopic myotomy for achalasia: predictors of successful outcome after 200 cases. Ann Surg 243:587–591; discussion 591–583PubMedCrossRefGoogle Scholar
  78. 78.
    Horgan S, Galvani C, Gorodner MV, Omelanczuck P, Elli F, Moser F, Durand L, Caracoche M, Nefa J, Bustos S, Donahue P, Ferraina P (2005) Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg 9:1020–1029; discussion 1029–1030PubMedCrossRefGoogle Scholar
  79. 79.
    Huffmanm LC, Pandalai PK, Boulton BJ, James L, Starnes SL, Reed MF, Howington JA, Nussbaum MS (2007) Robotic Heller myotomy: a safe operation with higher postoperative quality-of-life indices. Surgery 142:613–618; discussion 618–620PubMedCrossRefGoogle Scholar
  80. 80.
    Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN (2010) Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg 252:254–262PubMedCrossRefGoogle Scholar
  81. 81.
    Wang PC, Sharp KW, Holzman MD, Clements RH, Holcomb GW, Richards WO (1998) The outcome of laparoscopic Heller myotomy without antireflux procedure in patients with achalasia. Am Surg 64:515–520; discussion 521PubMedGoogle Scholar
  82. 82.
    Dempsey DT, Delano M, Bradley K, Kolff J, Fisher C, Caroline D, Gaughan J, Meilahn JE, Daly JM (2004) Laparoscopic esophagomyotomy for achalasia: does anterior hemifundoplication affect clinical outcome? Ann Surg 239:779–785; discussion 785–777PubMedCrossRefGoogle Scholar
  83. 83.
    Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO (2002) 100 consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg 235:631–638; discussion 638–639PubMedCrossRefGoogle Scholar
  84. 84.
    Bloomston M, Rosemurgy AS (2002) Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech 12:309–315PubMedCrossRefGoogle Scholar
  85. 85.
    Diamantis T, Pikoulis E, Felekouras E, Tsigris C, Arvelakis A, Karavokyros I, Bastounis E (2006) Laparoscopic esophagomyotomy for achalasia without a complementary antireflux procedure. J Laparoendosc Adv Surg Tech A 16:345–349PubMedCrossRefGoogle Scholar
  86. 86.
    Kjellin AP, Granqvist S, Ramel S, Thor KB (1999) Laparoscopic myotomy without fundoplication in patients with achalasia. Eur J Surg 165:1162–1166PubMedCrossRefGoogle Scholar
  87. 87.
    Burpee SE, Mamazza J, Schlachta CM, Bendavid Y, Klein L, Moloo H, Poulin EC (2005) Objective analysis of gastroesophageal reflux after laparoscopic Heller myotomy: an anti-reflux procedure is required. Surg Endosc 19:9–14PubMedCrossRefGoogle Scholar
  88. 88.
    Rossetti G, Brusciano L, Amato G, Maffettone V, Napolitano V, Russo G, Izzo D, Russo F, Pizza F, Del Genio G, Del Genio A (2005) A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long-term follow up. Ann Surg 241:614–621PubMedCrossRefGoogle Scholar
  89. 89.
    Kumar V, Shimi SM, Cuschieri A (1998) Does laparoscopic cardiomyotomy require an antireflux procedure? Endoscopy 30:8–11PubMedCrossRefGoogle Scholar
  90. 90.
    Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240:405–412PubMedCrossRefGoogle Scholar
  91. 91.
    Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M (2008) Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 248:1023–1030PubMedCrossRefGoogle Scholar
  92. 92.
    Rawlings A, Soper N, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2011) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective randomized-controlled trial. Surg Endosc 25:S210Google Scholar
  93. 93.
    Engstrom C, Lonroth H, Mardani J, Lundell L (2007) An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial. World J Surg 31:1221–1225; discussion 1226–1227PubMedCrossRefGoogle Scholar
  94. 94.
    Hagedorn C, Jonson C, Lonroth H, Ruth M, Thune A, Lundell L (2003) Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial. Ann Surg 238:189–196PubMedGoogle Scholar
  95. 95.
    Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669PubMedCrossRefGoogle Scholar
  96. 96.
    Zucker KA (2001) Minimally invasive surgery for achalasia. In: Zucker KA (ed) Surgical laparoscopy, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 467–491Google Scholar
  97. 97.
    Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230:587–593; discussion 593–584PubMedCrossRefGoogle Scholar
  98. 98.
    Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A (1992) Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 127:222–226; discussion 227PubMedCrossRefGoogle Scholar
  99. 99.
    Black J, Vorbach AN, Collis JL (1976) Results of Heller’s operation for achalasia of the oesophagus. The importance of hiatal repair. Br J Surg 63:949–953PubMedCrossRefGoogle Scholar
  100. 100.
    Simic AP, Radovanovic NS, Skrobic OM, Raznatovic ZJ, Pesko PM (2010) Significance of limited hiatal dissection in surgery for achalasia. J Gastrointest Surg 14:587–593PubMedCrossRefGoogle Scholar
  101. 101.
    Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, Nicoletti L, Cavallin F, Battaglia G, Ruol A, Ancona E (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248:986–993PubMedCrossRefGoogle Scholar
  102. 102.
    Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140:827–833; discussion 833–834PubMedCrossRefGoogle Scholar
  103. 103.
    Schuchert MJ, Luketich JD, Landreneau RJ, Kilic A, Gooding WE, Alvelo-Rivera M, Christie NA, Gilbert S, Pennathur A (2008) Minimally invasive esophagomyotomy in 200 consecutive patients: factors influencing postoperative outcomes. Ann Thorac Surg 85:1729–1734PubMedCrossRefGoogle Scholar
  104. 104.
    Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG (2008) The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 12:159–165PubMedCrossRefGoogle Scholar
  105. 105.
    Mineo TC, Pompeo E (2004) Long-term outcome of Heller myotomy in achalasic sigmoid esophagus. J Thorac Cardiovasc Surg 128:402–407PubMedCrossRefGoogle Scholar
  106. 106.
    Gorodner MV, Galvani C, Fisichella PM, Patti MG (2004) Preoperative lower esophageal sphincter pressure has little influence on the outcome of laparoscopic Heller myotomy for achalasia. Surg Endosc 18:774–778PubMedCrossRefGoogle Scholar
  107. 107.
    Pechlivanides G, Chrysos E, Athanasakis E, Tsiaoussis J, Vassilakis JS, Xynos E (2001) Laparoscopic Heller cardiomyotomy and Dor fundoplication for esophageal achalasia: possible factors predicting outcome. Arch Surg 136:1240–1243PubMedCrossRefGoogle Scholar
  108. 108.
    Rakita SS, Villadolid D, Kalipersad C, Thometz D, Rosemurgy A (2007) BMI affects presenting symptoms of achalasia and outcome after Heller myotomy. Surg Endosc 21:258–264PubMedCrossRefGoogle Scholar
  109. 109.
    Guardino JM, Vela MF, Connor JT, Richter JE (2004) Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol 38:855–860PubMedCrossRefGoogle Scholar
  110. 110.
    Duffy PE, Awad ZT, Filipi CJ (2003) The laparoscopic reoperation of failed Heller myotomy. Surg Endosc 17:1046–1049PubMedCrossRefGoogle Scholar
  111. 111.
    Gorecki PJ, Hinder RA, Libbey JS, Bammer T, Floch N (2002) Redo laparoscopic surgery for achalasia. Surg Endosc 16:772–776PubMedCrossRefGoogle Scholar
  112. 112.
    Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, Way LW (2001) Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg 136:870–877PubMedCrossRefGoogle Scholar
  113. 113.
    Gockel I, Kneist W, Eckardt VF, Oberholzer K, Junginger T (2004) Subtotal esophageal resection in motility disorders of the esophagus. Dig Dis 22:396–401PubMedCrossRefGoogle Scholar
  114. 114.
    Nehra D, Lord RV, DeMeester TR, Theisen J, Peters JH, Crookes PF, Bremner CG (2002) Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 235:346–354PubMedCrossRefGoogle Scholar
  115. 115.
    Reznik SI, Rice TW, Murthy SC, Mason DP, Apperson-Hansen C, Blackstone EH (2007) Assessment of a pathophysiology-directed treatment for symptomatic epiphrenic diverticulum. Dis Esophagus 20:320–327PubMedCrossRefGoogle Scholar
  116. 116.
    Rosati R, Fumagalli U, Bona S, Bonavina L, Peracchia A (1998) Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula? Ann Surg 227:174–178PubMedCrossRefGoogle Scholar
  117. 117.
    Honda H, Kume K, Tashiro M, Sugihara Y, Yamasaki T, Narita R, Yoshikawa I, Otsuki M (2003) Early stage esophageal carcinoma in an epiphrenic diverticulum. Gastrointest Endosc 57:980–982PubMedCrossRefGoogle Scholar
  118. 118.
    Streitz JM Jr, Ellis FH Jr, Gibb SP, Heatley GM (1995) Achalasia and squamous cell carcinoma of the esophagus: analysis of 241 patients. Ann Thorac Surg 59:1604–1609PubMedCrossRefGoogle Scholar
  119. 119.
    Klaus A, Hinder RA, Swain J, Achem SR (2003) Management of epiphrenic diverticula. J Gastrointest Surg 7:906–911PubMedCrossRefGoogle Scholar
  120. 120.
    Duda M, Sery Z, Vojacek K, Rocek V, Rehulka M (1985) Etiopathogenesis and classification of esophageal diverticula. Int Surg 70:291–295PubMedGoogle Scholar
  121. 121.
    D’Ugo D, Cardillo G, Granone P, Coppola R, Margaritora S, Picciocchi A (1992) Esophageal diverticula. Physiopathological basis for surgical management. Eur J Cardiothorac Surg 6:330–334PubMedCrossRefGoogle Scholar
  122. 122.
    Valentini M, Pera M, Vidal O, Lacima G, Belda J, de Lacy AM (2005) Incomplete esophageal myotomy and early recurrence of an epiphrenic diverticulum. Dis Esophagus 18:64–66PubMedCrossRefGoogle Scholar
  123. 123.
    Streitz JM Jr, Glick ME, Ellis FH Jr (1992) Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg 127:585–587; discussion 587–588PubMedCrossRefGoogle Scholar
  124. 124.
    Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, Murthy SC, Mason DP, Blackstone EH (2005) A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 130:1593–1600PubMedCrossRefGoogle Scholar
  125. 125.
    Del Genio A, Rossetti G, Maffetton V, Renzi A, Brusciano L, Limongelli P, Cuttitta D, Russo G, Del Genio G (2004) Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc 18:741–745PubMedGoogle Scholar
  126. 126.
    Fraiji E Jr, Bloomston M, Carey L, Zervos E, Goldin S, Banasiak M, Wallace M, Rosemurgy AS (2003) Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum. Surg Endosc 17:1600–1603PubMedCrossRefGoogle Scholar
  127. 127.
    Peillon C, Fromont G, Auvray S, Siriser F (2001) Achalasia: the case for primary laparoscopic treatment. Surg Laparosc Endosc Percutan Tech 11:71–75PubMedGoogle Scholar
  128. 128.
    Bonavina L, Incarbone R, Reitano M, Antoniazzi L, Peracchia A (2000) Does previous endoscopic treatment affect the outcome of laparoscopic Heller myotomy? Ann Chir 125:45–49PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Dimitrios Stefanidis
    • 1
  • William Richardson
    • 2
  • Timothy M. Farrell
    • 3
  • Geoffrey P. Kohn
    • 4
  • Vedra Augenstein
    • 1
  • Robert D. Fanelli
    • 5
  1. 1.Division of Gastrointestinal and Minimally Invasive Surgery, Department of General SurgeryCarolinas HealthCare SystemCharlotteUSA
  2. 2.Ochsner Clinic FoundationNew OrleansUSA
  3. 3.University of North CarolinaChapel HillUSA
  4. 4.Knox Private HospitalVictoriaAustralia
  5. 5.Berkshire Medical CenterPittsfieldUSA

Personalised recommendations