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Del Grande et al. Mini-invasive Surg 2017;1:121-5 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.23
www.misjournal.net
Topic: Achalasia Management: the South American viewpoint Open Access

One size fits all: laparoscopic Heller’s

myotomy for the treatment of achalasia

irrespective of the degree of dilatation

Leonardo de Mello Del Grande , Fernando A. M. Herbella , Marco G. Patti , Francisco Schlottmann 2
1
2
1
1 Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04037-003, Brazil.
2 Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Correspondence to: Dr. Fernando A. M. Herbella, Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Rua Diogo de Faria
1087 cj 301, São Paulo, SP 04037-003, Brazil. E-mail: herbella.dcir@epm.br

How to cite this article: Del Grande LM, Herbella FAM, Patti MG, Schlottmann F. One size fits all: laparoscopic Heller’s myotomy for the treatment
of achalasia irrespective of the degree of dilatation. Mini-invasive Surg 2017;1:121-5.

ABSTRACT
Article history: Laparoscopic Heller’s myotomy is the most common surgical procedure to treat achalasia. It
Received: 15 Jun 2017 is the most accepted therapy for non-advanced stages of the disease. In the setting of advanced
Accepted: 30 Aug 2017 disease with marked esophageal dilatation or sigmoid-shaped esophagus the ideal surgical
Published: 30 Sep 2017 procedure is debatable. Esophagectomy is believed by several authors to be the operation of
choice in these cases. Others; however, opt for less invasive alternatives. Laparoscopic Heller’s
Key words: myotomy has been shown to be a safe and resourceful alternative in end-stage achalasia as well.
Achalasia,
surgery,
myotomy,
end-stage disease

INTRODUCTION the severity of the disease and may be used as a
guide to tailor treatment according to some authors .
[5]
Achalasia is a rare neurodegenerative primary There is no consensus on the threshold of esophageal
esophageal motor disorder characterized by diameter to consider the disease as end-stage. While
abnormal lower esophageal sphincter relaxation and some adopt the limit in 6 cm , others prefer 7 cm .
[6]
[7]
aperistalsis . The disease may be idiopathic or In Brazil, 4 different stages of esophageal dilatation
[2]
[1]
secondary to Chagas’ disease - a tropical disease are considered and end-stage disease is defined by
[8]
common in Latin America , although both forms have diameterover 10 cm .
[3]
[9]
distinct etiology they share the same pathophysiology.
End-stage disease with marked esophageal dilatation
or sigmoid-shaped esophagus is; however, more Laparoscopic Heller’s myotomy (LHM) is the most
frequent in Chagas’ disease patients [Figure 1] . common surgical procedure to treat achalasia. It is
[4]
the most accepted therapy for non-advanced stages
The degree of esophageal dilatation is used to grade of the disease [10] . In the setting of advanced disease
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