Chirurgische Therapie der Achalasie

Laparoscopic myotomy is currently the treatment of choice for achalasia of stages I and II in patients younger than 40 years of age. In patients of older age, pneumatic dilatation may be priorily attempted. However, it should not be performed more than twice. In our own group of patients, half of the patients are treated by pneumatic dilatation and the other half by cardiomyotomy. Laparoscopic cardiomyotomy should always be combined with a so called fundoplasty according to Dor/Thal in order to prevent postoperative reflux or scar-induced dysphagia. In final stages of achalasia with massive dilatation of the esophagus with bulging of its distal part, esophagectomy is indicated. Beyond of massive problems of stasis related dysphagia, the high risk of squamous cell carcinoma warrant this more invasive approach.