| Theme |
Lesions of Esophagogastric Junction -- Its Diagnostic and Therapeutic Strategies |
| Title |
Achalasia of the Esophagus |
| Author |
Soji Ozawa |
Department of Surgery, School of Medicine, Keio University |
| Author |
Yuko Kitagawa |
Department of Surgery, School of Medicine, Keio University |
| Author |
Eiichi Nakamura |
Department of Surgery, School of Medicine, Keio University |
| Author |
asaki Kitajima |
Department of Surgery, School of Medicine, Keio University |
| [ Summary ] |
Achalasia is a motor disorder of the esophagus characterized by loss of esophageal peristalsis and failure of the lower esophageal sphincter (LES) to completely relax upon deglutition. For the diagnosis of achalasia, symptoms such as dysphagia should be evaluated and esophagograms, endoscopy, or manometric studies should be performed. There are four methods of treatment, the first is medical therapy, the second is botulinum toxin injection therapy, the third is pneumatic dilatation, and the fourth is surgery. Recently, laparoscopic Heller myotomy and Dor fundoplication (Heller and Dor operations) have been thought to be the operation of first choice. As Csendes et al. reported; surgical treatment was better than pneumatic dilatation and as laparoscopic surgery is less invasive, the indications for laparoscopic Heller and Dor operations can include all achalasia patients, except those patients who respond to medical therapy, patients who will not accept operations, or patients who can not tolerate an operation because of poor overall condition. We successfully performed laparoscopic Heller and Dor operations on 35 patients and the postoperative courses were all uneventful. Surgeons considering surgical procedures, should know that laparoscopic Heller and Dor operations are an ideal, minimally invasive treatment for esophageal achalasia. |