Achalasia is a disease process caused by a failure of the lower esophageal sphincter to relax and absent motility of the esophageal body. Its onset is often insidious and can occur over the span of years. Patients often begin with difficulty swallowing solids and eventually progress to difficulty swallowing liquids. Other symptoms include regurgitation, chest pain, heartburn, and weight loss. The cause of achalasia is unknown.

Traditionally, achalasia has been treated with dilitation. In 1674 Sir Thomas Willis describes the case of a patient who was treated successfully by dilatation with a whale bone. Pneumatic dilatation yields excellent or good symptomatic results in 60-90% of patients. The risk of perforation is approximately 5%. Perforation often will lead to emergency surgery. There have been some trials of medications for achalasia but all have given poor symptomatic relief.

In the past several years a new therapy for achalasia has been injection of Botulinum toxin injection into the lower esophageal muscle to paralyze the muscle and thus leads to relaxation. This sometimes gives good short term results but often requires treatments every 6 months to a year. This treatment however makes surgical intervention much more difficult if that would ever be a consideration.

Surgical therapy for achalasia has been around for many years. In 1913 Heller performed the first bilateral longitudinal esophageal myotomy. The procedure has since been modified over the years but is known today as the "Heller myotomy." In the last five to ten year the procedure is now being performed with the aid of the laparoscope or videoscope. This has significantly decreased the morbidity of the Heller myotomy when compared to the original open operation. This allows patients to get back to work or school much quicker.

At Advanced Surgical Associates, we evaluate and treat patients with symptoms of achalasia with the goal of improving one's lifestyle. We believe this can be done safely by the well-trained surgeon accomplished in advanced laparoscopic techniques.