Achalasia – position of surgery in current management

Česká verzia

Authors: M. Stašek; Č. Neoral; R. Vrba; R. Aujeský; Dušan Klos
Authors place of work: 1. chirurgická klinika Fakultní nemocnice Olomouc a Lékařské fakulty Univerzity Palackého v Olomouci
Published in the journal: Rozhl. Chir., 2022, roč. 101, č. 4, s. 148-153.
Category: Review
doi: https://doi.org/10.33699/PIS.2022.101.4.148–153

Summary

Oesophageal achalasia is a serious cause of dysphagia. Therapeutic options for achalasia include endoscopic and surgical methods. Indications for individual methods overlap to a certain extent and require careful diagnosis.

The review article describes individual methods, focusing particularly on the issues of indications of pneumatic dilatation, peroral endoscopic myotomy (POEM) and laparoscopic or robotic Heller’s myotomy. Special attention is paid to revision procedures after Heller’s myotomy. The main added value of POEM is the treatment of spastic disorders of the oesophagus and re-do myotomy.

Type 2 achalasia can be treated with dilatation, POEM and HM; type 1 achalasia can be treated using the same modalities. For type 3, POEM is the current method of choice. Despite the current emphasis on endoscopic myotomy, surgical therapy, especially laparoscopic or robotically assisted Heller’s myotomy, remains a safe therapeutic option. It is indicated especially in patients who are not suitable for endoscopic therapy or those with advanced achalasia findings.

In the future, identification of the risk of postoperative complications (perforation, reflux) should lead to differentiation of the indication of the laparoscopic (robotic) approach and POEM, or it may lead to a synchronous or metachronous indication of the cuff construction.

Keywords:

achalasia – laparoscopic Heller’s myotomy – peroral endoscopic myotomy – oesophageal reflux disease – oesophageal perforation

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