Esophagectomy for recurrent dysphagia in esophageal motility disorders

Achalasia is the most common primary esophageal motility disorder. Unfortunately, its etiology is unknown so that treatment is palliative and it is directed toward the elimination of the resistance posed by a nonrelaxing and often hypertensive lower esophageal sphincter. Pneumatic dilatation, laparoscopic Heller myotomy, and peroral endoscopic myotomy are very effective in relieving symptoms but often their effect is limited in time. In patients who have failed other treatment modalities and in whom symptoms affect the quality of life, an esophagectomy may be required. This is often a challenging operation that should be done by expert surgeons because of scar tissue from prior interventions and an esophagus which often very dilated and sigmoid.