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Esophageal achalasia, a rare primary motility disorder, stems from the loss of inhibitory nitregic neurons within the esophageal myenteric plexus, leading to impaired peristalsis and sphincter relaxation during swallowing. Characterized by its rarity, it affects an estimated 1 per 100,000 people with a prevalence of 10 per 100,000.
Diagnosis primarily relies on high-resolution esophageal manometry (HREM), categorizing achalasia into three types based on motility patterns. Despite various treatment modalities—pharmacologic, endoscopic, and surgical—aiming to alleviate lower esophageal sphincter hypertonicity, restoration of normal peristalsis remains elusive.
Pharmacologic approaches, limited in efficacy, are typically reserved for non-surgical candidates. Surgical interventions, including pneumatic dilatation, Heller myotomy, Dor fundoplication, and per-oral endoscopic myotomy (POEM), are frequently employed. Notably, Heller myotomy and fundoplication demonstrate superior long-term clinical outcomes.
An evaluation spanning two decades (June 1999 - June 2019) involving 111 patients undergoing minimally invasive treatments—96 laparoscopic and 15 robotic—examined the effectiveness of laparoscopic Heller myotomy and Dor fundoplication. Patient demographics revealed a mean age of 49 years and a dysphagia duration averaging 96 months. Among those undergoing pH monitoring, 18 cases exhibited pathologic reflux out of 50 patients.