Achalasia is an esophageal motility disorder in which the esophagus does not function properly. The main body of the esophagus does not have proper coordinated movement or peristalsis and the valve between the esophagus called the lower esophageal sphincter does not relax when food reaches the valve.
Patients with achalasia often present with difficulty swallowing both solid and liquid foods and at times vomiting up the food that they just ate. This is typically a gradual process where the patients develop difficulty swallowing over time. The diagnosis of this disorder is made initially with barium esophagram then followed by a high-resolution esophageal manometry. Patients may also get an endoscopy and biopsy to confirm the diagnosis.
Once the patient is diagnosed with achalasia, the treatment options include balloon dilatation, Botox injection and Heller myotomy to open up the lower esophageal sphincter so that food can go down from the esophagus to the stomach. However, both balloon dilatation and Botox injection are short-term solutions for this problem and typically the symptoms return after several months. Heller myotomy is currently the best treatment for patients with achalasia, providing long lasting relief for this motility disorder.
There are several approaches for Heller myotomy. The surgical options are open, laparoscopic, thoracoscopic, robot-assisted and POEM or per-oral endoscopic Heller myotomy in which muscle layers of esophagus and stomach are cut to make the lower esophageal sphincter incompetent. Typically for the open, laparoscopic and robot-assisted approaches, patients also receive fundoplication to help prevent reflux from developing after the lower esophageal sphincter has been made incompetent.
In our practice, we offer Robot-assisted Heller myotomy with Dor fundoplication performed with Endoflip. We feel that this approach will provide relief from achalasia but also prevent the development of severe reflux.