PubMed · 14304606
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R BERGER, L POKA. 1965-04-10. [DIFFUSE ESOPHAGEAL SPASM].. https://pubmed.ncbi.nlm.nih.gov/14304606/
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Achalasia is a rare neurologic deficit of the esophagus, producing a syndrome of impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body for which the cause is unknown. The resultant chronic esophageal stasis produces discomforting symptoms that can be managed with medication, chemical paralysis of the lower esophageal sphincter, mechanical dilation, or surgical esophagomyotomy. Chemical paralysis by injection of the esophagus with botulinum toxin and dilation with an inflatable balloon offers good short-term relief of symptoms; however, the best long-term results are produced by surgery, and advancing minimally invasive techniques continually reduce the morbidity of these operations. The type of surgical procedure, the necessity for fundoplication, and the order of treatment continue to be unresolved issues, but prospective evaluation with objective followup should allow us to provide the optimal treatment regimen to our patients.
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The standard surgical treatment for esophageal achalasia is improvement of the passage combined with antireflux repair. This paper describes the techniques of the laparoscopic modified Girard myotomy and fundoplication for achalasia. The laparoscopic modified Girard myotomy and fundoplication were performed through five upper abdominal trocars. A 10 cm myotomy extended 8 cm above the gastroesophageal junction and 2 cm below the gastroesophageal junction using an electric J-hook. Transverse sutures were placed on each side of the lower myotomy. The gastric fundus was covered with the upper myotomy with several sutures. Twenty-three patients were treated using this method. Excellent results were achieved. The laparoscopic modified Girard myotomy and fundoplication appear to provide effective treatment of achalasia with minimal invasion and rapid rehabilitation.