This is when the muscles of the esophagus do not function normally. The most common problem is achalasia. This occurs due to a combination of ineffective esophageal peristalsis (the muscle contractions that push food down to the stomach) and incomplete relaxation of the lower esophageal sphincter (the valve that allows food to enter the stomach). Symptoms include difficulty swallowing, chest pain, weight loss, and regurgitation.
Treatments for Achalasia
Medications and endoscopic techniques (dilation or Botox) are often used to treat achalasia, but these treatments are not long-lasting and symptoms recur. Surgery provides long-term relief from this problem.
Surgery should be considered first line therapy for patients who are qualified surgical candidates. Surgery is directed towards dividing the lower esophageal sphincter muscle in order to allow food to pass easily into the stomach. Here at Mount Sinai, our distinguished thoracic surgeons use minimally invasive techniques to accomplish this.
The most common minimally invasive technique we employ is called laparoscopic Heller myotomy (LHM) and involves making several small incisions in the abdomen and using a camera and instruments to divide the sphincter muscle. In certain circumstances where operating in the abdomen is not ideal, we perform VATS Heller myotomy (VHM). This operation is achieved with several small incisions along the side of the left chest and the use of a camera and instruments to divide the sphincter muscle. Patients are usually discharged home the next day. The small incisions are barely visible within several weeks of the operation.
Achalasia and Esophageal Diverticulum
Patients with achalasia may also develop an esophageal diverticulum – an abnormal outpouching of the esophagus. In addition to symptoms of achalasia, patients may experience regurgitation of food several hours after eating or halitosis (bad breath). Surgery is best achieved with minimally invasive techniques in the chest since, in addition to dividing the sphincter muscle, the diverticulum usually needs to be resected as well.
If the achalasia is left untreated for too long, the esophagus becomes too dilated and tortuous such that food is unable to navigate down into the stomach. In these events, we still try a Heller myotomy as a first line option, but it may not be effective. Oftentimes, the only recourse is an esophagectomy (removing the entire esophagus). At Mount Sinai, our thoracic surgeons have expertise in minimally invasive esophagectomy (MIE), which employs minimally invasive techniques through the abdomen and the chest to remove the entire esophagus.
Dr. Dong-Seok Lee