Laparoscopic Myotomy for Achalasia
Achalasia is a disease of the muscle of the esophagus that effects primarily the lower esophageal valve separating the esophagus and stomach. The resulting spasm of the valve prevents ingested food from reaching the stomach easily. The cause of this disorder is unknown. Patients usually complain of intermittent regurgitation and food "sticking" after swallowing.

Diagnostic Studies
Barium Swallow - Patients are asked to swallow a liquid which will be visible on an X-ray. A series of X-rays are then taken. Achalasia patients will often demonstrate abnormal valve relaxation and an absence of normal contractions.
Esophageal Manometry - Pressure recordings are assessed in this exam through a small catheter placed into the esophagus. Characteristic findings in patients with achalasia include an elevated lower valve pressure and failure of the valve to relax with swallowing.
Endoscopy - This is a procedure in which a small, flexible telescope is passed through the mouth into the esophagus. The lining of the esophagus can then be examined and biopsied.

Management
Medical therapy for achalasia with drugs that relieve the spasm of the sphincter has largely been unsuccessful and associated with numerous side effects. The classical method for treatment remains endoscopic balloon dilatation and surgery. While dilatation can achieve a good result in up to 60% of patients, the results are frequently not durable. Also, dilatation carries the risk of esophageal perforation which would require emergency surgery.

Historically, definitive surgical treatment for patients with achalasia included a formal rib spreading incision to perform an esophageal myotomy or splitting of the abnormally thickened esophageal muscle at the lower sphincter. Recent improvements in laparoscopy have allowed for significant advances in the treatment of achalasia. We are currently performin a laparoscopic myotomy for most of our achalasia patients. This approach requires small abdominal incisions for the placement of a camera and telescopic instruments. The abnormally thickened muscle surrounding the esophagus is incised to allow for improved swallowing. After completion of this myotomy a gastric fundoplication or loose stomach wrap is created around the esophagus to minimize reflux.

Length of stay has been reduced to two days with minimal post-operative discomfort. Also, patients are tolerating regular food at the time of discharge.