Treatment of Esophageal Achalasia with Emphasis on Laparoscopic Heller Cardiomyotomy

Abstract

Background: Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter relaxation and absence or abnormality of esophageal peristalsis. No available treatment can reverse ganglion-cell degeneration, restore lost esophageal neurons, or normalize esophageal motility. Current therapies are therefore directed toward reducing lower esophageal sphincter pressure, relieving functional obstruction, facilitating esophageal emptying, and improving dysphagia and regurgitation.

Objective: To review the treatment options for esophageal achalasia, with particular emphasis on laparoscopic Heller cardiomyotomy, including patient selection, operative principles, the role of partial fundoplication, clinical outcomes, complications, and comparison with pneumatic dilation and peroral endoscopic myotomy.

Conclusion: Laparoscopic Heller myotomy remains a major definitive treatment for esophageal achalasia and provides effective symptomatic relief by dividing the circular muscle fibers of the distal esophagus and proximal stomach while preserving the mucosa. Addition of a partial fundoplication reduces postoperative gastroesophageal reflux. Appropriate patient selection, adequate myotomy, careful mucosal preservation, and structured follow-up are essential for favorable outcomes and early detection of recurrent dysphagia or reflux.