RT Book, Section
A1 Hinojosa, Marcelo W.
A1 Oelschlager, Brant K.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Colson, Yolonda L.
A2 Jaklitsch, Michael T.
A2 Krasna, Mark J.
A2 Mentzer, Steven J.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1105839817
T1 Esophagocardiomyotomy for Achalasia (Heller)
T2 Adult Chest Surgery, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-178189-3
LK accesssurgery.mhmedical.com/content.aspx?aid=1105839817
RD 2024/04/20
AB In  1914,  Ernest  Heller  described  the  first  cardiomyotomy  for  the  treatment  of  achalasia.1  He  described  an  anterior  and  posterior  myotomy  along  the  gastroesophageal  junction  (GEJ)  using  a  thoracoabdominal  incision.  The  operation  was  subsequently  modified  by  Groenveldt  and  Zaaijer  to  include  only  the  anterior  myotomy.  Owing  to  the  morbidity  of  the  open  approach,  this  operation  was  performed  primarily  in  patients  who  failed  medical  management.  It  was  not  until  the  early  1990s  with  the  advent  of  minimally  invasive  techniques  that  minimally  invasive  esophagocardiomyotomy  became  a  viable  first-line  therapy.  This  operation  has  yielded  excellent  results,  with  90%  to  95%  of  patients  receiving  durable  relief  of  dysphagia.2-5  At  the  University  of  Washington,  we  converted  from  a  thoracoscopic  approach  to  a  laparoscopic  Heller  myotomy  in  1994,  and  along  with  most  centers,  we  now  consider  laparoscopic  esophageal  myotomy  to  be  an  excellent  first-line  therapy  because  of  the  low  morbidity,  durability,  and  the  high  levels  of  success  after  minimally  invasive  esophagocardiomyotomy.3,6–9