A swallowing disorder such as achalasia requires the right diagnosis and best possible treatment in order to regain better function. At Mount Sinai, our highly skilled surgeons partner with other specialists, your primary care doctor, and a supportive staff to ensure you receive the best possible care.
Normal swallowing requires the muscular valve at the entrance to the stomach (the lower esophageal sphincter (LES)) to relax to allow food and liquid to pass through. Achalasia is a rare condition that occurs when this valve fails to relax. Difficulty swallowing liquids and solids, chest pain, and regurgitation are common symptoms of this disorder. In time, the esophagus may become dilated and lose its ability to contract normally. The diagnosis of achalasia is made with a combination of x-rays (a barium swallow or esophagram), endoscopy, and esophageal manometry.
Treatments for Achalasia
There are multiple therapies for treating achalasia. Non-surgical options include medications, botulinum toxin injections, and esophageal dilations, which generally provide temporary management. Surgical options include laparoscopic Heller myotomy, which is the most permanent solution available.
Laparoscopic Heller myotopy is a procedure in which the esophageal sphincter muscle is cut (esophagomyotomy), allowing the muscle to relax. The success rate of this procedure is about 90 percent, with few patients who need to have a second surgery. In many cases, patients who undergo a laparoscopic Heller myotomy develop GERD afterwards. To prevent GERD, the surgeons at Mount Sinai may perform nissen fundoplication (a procedure to wrap the upper stomach around the lower esophagus) during the same operation to prevent reflux.
The benefits of laparoscopic Heller myotomy include less blood loss, minimal scarring, and decreased chance of infection, as well as shorter hospital stays and recovery times. Most people who undergo this procedure are able to leave the hospital the next day and can resume their activities after a relatively short amount of time.