Laparoscopic
Myotomy for Achalasia
Most patients with achalasia have had symptoms developing
over 5-10 years. Initially it may be merely that they
notice that they finish their meals last, taking longer
to complete a meal. Commonly there is difficulty in
swallowing food and liquids, but regurgitation, halitosis,
and even bouts of chest pain associated with oesophageal
spasm may lead to presentation to a doctor. It is
during the late stages that inability to swallow leads
to weight loss and nutritional compromise.
Cause
Inability of the lower oesophageal sphincter to relax
and weak and uncoordinated oesophageal contractions
lead to the clinical manifestations.
The underlying cause is thought to be due to damaged
nerves within the oesophagus and sphincter itself.
All remedies try to address the tight non relaxing
sphincter which is the cause of the hold up. The weak
contraction of the oesophagus can very occasionally
be improved by relief of the hold up downstream.
Balloon dilatation can achieve good results but repeated
attempts are associated with increased risk of complications.
Cutting the muscle of the sphincter can be carried
out as the initial definitive procedure or in patients
who have suffered a recurrence after balloon dilatation.
Surgery after repeated dilatations or manipulations
may be harder due to fibrosis.
Preparation for the
procedure
The oesophagus is slow to empty so patients are asked
to be on a liquid diet for at least 48 hours preop.
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