Achalasia of the Esophagus
Achalasia is a motility disorder in which peristalsis is decreased in the body of the esophagus and the distal esophageal sphincter fails to relax properly during swallowing. The combination results in progressive inability to swallow. Early in the disease process, lower esophageal hypertrophy and failure to relax dominate the clinical picture, and hence the initial treatment is directed at this location. Various methods have been employed to disable or weaken the sphincter mechanism. Surgical therapy is employed when medical therapy or pneumatic dilatation are ineffective. This chapter explores alternatives in surgical therapy of uncomplicated achalasia. Chapter 15 discusses fundoplication as an adjunct to laparoscopic myotomy.
KeywordsLower Esophageal Sphincter Distal Esophagus Gastric Cardia Heller Myotomy Pneumatic Dilatation
Unable to display preview. Download preview PDF.
- De Brune Groenveldt JR. Over cardiospasmus. Ned Tijdschr Geneeskd 1918;54:1281-1282.Google Scholar
- Heller E. Extramucöse Cardioplastie beim chronischen Cardiospasmus mit Dilatation des Oesophagus. Mitt Grengeb Med Chir 1913;2:141-149.Google Scholar
- Ellis FH Jr, Olsen AM, Holman CB, et al. Surgical treatment of cardiospasm: consideration of aspects of esophagomyotomy. JAMA 1958;166:29.Google Scholar
- Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL. Laparo-scopic Heller myotomy with Toupet fundoplication: outcome predictors in 121 con-secutive patients. Arch Surg 2005;140;9:827-833.Google Scholar
- Leyden JE, Moss AC, MacMarhuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database of Sys-tematic Reviews 2006;4:CD005046.Google Scholar