Achalasia of the Cardia
The understanding of achalasia has evolved over time, and today the disease is defined manometrically by a non-relaxing lower oesophageal sphincter (LES) in association with aperistalsis of the oesophageal body.
We believe that there are two very important aspects in the surgical management of achalasia that are vital to obtaining excellent outcomes: patient selection and operative technique.
Thus, this chapter will describe a series of “tips” and “tricks” that we have used in those two domains. Because the chapter is directed to the practicing surgeon, we will follow the order in which a potential patient moves through the system starting with all aspects of diagnosis (or patient selection) and then continuing on through surgery.
The operation initially described by Heller has undergone numerous modifications in the last two decades as we learned the importance of a laparoscopic (rather than thoracoscopic) approach, the wisdom of an “extended myotomy” (more than 3 cm below the cardia), and the advantages associated with a partial anti-reflux procedure.
We will also address the treatment of “megaesophagus” and the role that myotomy plays vs. that of esophagectomy, and lastly we will examine the new endoscopic procedures that have been described.
KeywordsAchalasia Laparoscopic Standard Extended Heller Myotomy Tips Tricks Surgical Treatment
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