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The Evolution of the Treatment of Esophageal Achalasia: From the Open to the Minimally Invasive Approach

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Abstract

Background

Achalasia is a primary esophageal motility disorder characterized by lack of esophageal peristalsis and partial or absent relaxation of the lower esophageal sphincter in response to swallowing. This study aimed to provide an overview of the evolution of the surgical treatment for esophageal achalasia, from the open to the minimally invasive approach.

Methods

Literature review.

Results

No curative treatment exists for this disorder. At the beginning of the 20th century, surgical esophagoplasties and cardioplasties were mostly done to treat achalasia. The description of the esophageal myotomy by Heller changed the treatment paradigm and rapidly became the treatment of choice. For many years the esophagomyotomy was done with either an open transthoracic or transabdominal approach. With the advancements of minimally invasive surgery, thoracoscopic and laparoscopic operations became available. The ability to add a fundoplication for the prevention of reflux made the laparoscopic Heller myotomy with partial fundoplication the operation of choice.

Conclusions

Surgical management of esophageal achalasia has significantly evolved in the last century. Currently, minimally invasive Heller myotomy with partial fundoplication is the standard surgical treatment of achalasia.

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Author information

Authors and Affiliations

  1. Division of Esophageal and Gastric Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon1640, Buenos Aires, Argentina

    Francisco Schlottmann

  2. Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA

    Francisco Schlottmann

  3. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil

    Fernando A. M. Herbella

  4. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Marco G. Patti

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  1. Francisco Schlottmann
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  2. Fernando A. M. Herbella
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  3. Marco G. Patti
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Correspondence to Francisco Schlottmann.

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Francisco Schlottmann, Fernando A.M. Herbella, and Marco G. Patti declare that they have no conflict of interest.

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Schlottmann, F., Herbella, F.A.M. & Patti, M.G. The Evolution of the Treatment of Esophageal Achalasia: From the Open to the Minimally Invasive Approach. World J Surg 46, 1522–1526 (2022). https://doi.org/10.1007/s00268-022-06482-4

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