ABSTRACT
Due to the absence of an etiologic therapy, the medical community has focused treatment around how to palliate dysphagia, the main symptom of achalasia. For many years, surgery has represented the most effective therapy for achalasia. Diagnostic work-up comprises esophageal high resolution manometry (HRM), barium swallow, and endoscopy. Endoscopy is most commonly the primary investigation to be performed in a patient with dysphagia. Patients should be kept on a liquid diet for 24 hours before the operation, and a dilated gullet should be mechanically washed and emptied via a naso-esophageal tube the night before the procedure. The operation is performed under general anesthesia and oro-tracheal intubation. Laparoscopic Heller myotomy combined with partial fundoplication is a remarkably safe operation with a reported mortality of 0.1". The most common complication is perforation of the esophageal or gastric mucosa during the myotomy.
