Abstract
The cause of the parasympathetic neuropathy in achalasia remains unknown. The treatment of this distressing condition varies from medication with nitrates and calcium-blocking agents, disruption of the lower oesophageal sphincter by balloon dilatation, advocated by gastroenterologists, to surgical intervention. The results of medication with nitrates are indifferent, and the early promise of the value of nifedipine has not be confirmed by prospective studies. Surgical treatment consists of a short 5.0–6.0-cm myotomy which includes the whole extent of the lower oesophageal high pressure zone and adjacent 1.0 cm of stomach. In the only reported prospective study comparing the two techniques, the outcome following myotomy was successful in 95% as compared to 65% after balloon dilatation. Opinions also differ amongst surgeons with regard to the approach: thoracic or abdominal. The disadvantage of open surgical myotomy is the precipitation of gastro-oesophageal reflux, the reported incidence of which varies considerably.
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References
Andreollo NA, Earlam RJ (1987) Heller’s myotomy for achalasia: is added anti-reflux procedure necessary? Br J Surg 74: 765–769
Black J, Vorbach AN, Liegh-Collis J (1976) Results of Hellers operation for achalasia of the oesophagus. The importance of hiatal hernia repair. Br J Surg 63:949–953
Crookes WG, Wilkinson AJ. Johnston GW (1989) Hellers myotomy with partial fundoplication. Br J Surg 76: 99–100
Csendes A, Braghetto I, Henrique J A, Cortes C (1989) Late results of a prospective randomized study comparing forceful dilatation and oesophagomyotomy in patients with achalasie. Gut 30:299–304
Cuschieri A, Shimi S, Nathanson LK (1991) Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 36:152–154
Ellis FH, Gibb SP, Crozier RE (1980) Esophagomyotomy for achalasia of the esophagus. Am Surg 86: 157–161
Gelfand MD, Kozarek RA (1989) An experience with poylethylene balloons for pneumatic dilatation in achalasia. Am J Gastroenterol 84:924–927
Shimi S, Nathanson LK, Cuschieri A (1991) Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 36: 152–154
Traube M, Dubovik S, Lange RC, McCallum RW (1989) The role of nifedipine therapy in achalasia: results of a randomized double-blind, placebo-controlled study. Am J Gastroenterol 84:1259–1262
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© 1992 Springer-Verlag Berlin Heidelberg
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Cuschieri, A., Shimi, S.M., Nathanson, L.K. (1992). Laparoscopic Cardiomyotomy for Achalasia. In: Cuschieri, A., Buess, G., Périssat, J. (eds) Operative Manual of Endoscopic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-22257-7_25
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DOI: https://doi.org/10.1007/978-3-662-22257-7_25
Publisher Name: Springer, Berlin, Heidelberg
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