Laparoscopic Cardiomyotomy for Achalasia

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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. Keywords Balloon Dilatation Anterior Surface Hiatal Hernia Repair Lower Oesophageal Sphincter Abdominal Oesophagus These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.