EDITORIAL   

Chirurgia 2000 October-December;13(5-6):247-52

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Evolution in the treatment of esophageal achalasia

Feo C. V., Zamboni P., Liboni A., Patti M. G.

Achalasia is a rare disease of the esophagus, characterized by the absence of peristalsis in the esophageal body and incomplete relaxation of a hyperthensive lower esophageal sphincter. The cause of the disease is unknown; therefore, the aim of therapy is to improve esophageal emptying by eliminating the outflow resistance caused by the lower esophageal sphincter. This goal can be accomplished by either pneumatic dilatation or surgical cardiomyotomy, which are the only long term, effective therapies for the treatment of achalasia. In fact, medications such as channel blockers are ineffective, and botulinum toxin injection appears to offer only short-term relief of symptoms. Historically, pneumatic dilatation was preferred to surgery because of the morbidity associated with a thoracotomy or a laparotomy. However, with the development of minimally invasive techniques, the surgical approach has gained widespread acceptance among patients and gastroenterologists. Therefore, the role of surgery in the treatment of esophageal achalasia seems to be changing. The aim of the paper was to review the changes occurred in the surgical treatment of achalasia over the past decade: specifically, the development of minimally invasive technique and the evolution from the thoracoscopic approach without an anti-reflux procedure to the laparoscopic myotomy with either a Dor or a Toupet fundoplication.