Laparoscopic treatment for esophageal achalasia: experience at a single center.

Abstract

Background. Achalasia is a not frequent esophageal disorder cha- racterized by the absence of esophageal peristalsis and incomplete re- laxation of the lower esophageal sphincter (LES). Its cause is unknown. The aim of treatment is to improve the symptoms. We report the results of the treatment of this condition achieved in one center. Patients and methods. We conducted a retrospective study of pa- tients with esophageal achalasia. In the period 2010-2012 we observed 64 patients, of whom 19 were referred for medical treatment. Three of Introduction Achalasia is a not frequent esophageal motor disor- der that affects both the body of the esophagus and the lower esophageal sphincter (LES). It involves loss of nor- mal peristalsis and sphincter hypertonia, and symptoms are debilitating (1). Its etiology is still unknown, for whi- ch reason no specific treatment is available. The possi- ble therapeutic options are all symptomatic and invol- ve the use of drugs, endoscopy (injection of botulinum toxin, pneumatic dilatation) and surgery. Treatment is based on the delicate balance between removing the func- tional obstruction, thus improving symptoms, and the need to avoid uncomfortable major consequences such as gastroesophageal reflux, peptic stricture, Barrett’s the remaining patients underwent botulinum toxin injection, 17 un- derwent multiple endoscopic dilation procedures and 25 underwent la- paroscopic surgery. Results. There were no complications in the group undergoing en- doscopic therapy, but symptom remission was only temporary. Patients undergoing surgery showed a significant improvement in symptoms and no recurrence throughout the follow-up period, that is still ongoing (3 years). There were no major complications in any case and no morbi- dity or mortality. Conclusions. Surgical treatment of esophageal achalasia with la- paroscopic Heller myotomy and Dor fundoplication gives the best and longest-lasting results in suitably selected patients. The extension of the myotomy and reduction in LES pressure are the most important para- meters to achieve a good result.