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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2015; 21(38): 10830-10839
Published online Oct 14, 2015. doi: 10.3748/wjg.v21.i38.10830
Data analyses and perspectives on laparoscopic surgery for esophageal achalasia
Kazuto Tsuboi, Nobuo Omura, Fumiaki Yano, Masato Hoshino, Se-Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Hideyuki Kashiwagi, Katsuhiko Yanaga
Kazuto Tsuboi, Nobuo Omura, Fumiaki Yano, Masato Hoshino, Se-Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Hideyuki Kashiwagi, Katsuhiko Yanaga, Department of Surgery, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Author contributions: Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, Masuda T and Kashiwagi H analyzed data; Tsuboi K, Omura N and Yanaga K wrote the paper.
Conflict-of-interest statement: Drs. Tsuboi, Omura, Yano, Hoshino, Yamamoto, Akimoto, Masuda, Kashiwagi and Yanaga have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazuto Tsuboi, MD, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan. kazuto@jikei.ac.jp
Telephone: +81-3-34331111 Fax: +81-3-54724140
Received: April 9, 2015
Peer-review started: April 9, 2015
First decision: May 18, 2015
Revised: May 29, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 14, 2015
Abstract

In general, the treatment methods for esophageal achalasia are largely classified into four groups, including drug therapy using nitrite or a calcium channel blocker, botulinum toxin injection, endoscopic therapy such as endoscopic balloon dilation, and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913, but the most common approach has changed from open-chest surgery to laparoscopic surgery. Currently, the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy, to thoracoscopic surgery, and to laparoscopic surgery, the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux, but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently, a new endoscopic approach, peroral endoscopic myotomy (POEM), has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia.

Keywords: Esophageal achalasia, Surgery, Treatment, Review, Laparoscopy

Core tip: Esophageal achalasia is the most common primary esophageal motility disorder and the major symptoms are dysphagia, vomiting, and chest pain. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy and the basic concept of surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction. However, the most common approach has changed from open-chest surgery to laparoscopic surgery. This article reviews the outcomes of surgical procedures for esophageal achalasia from various view points and discusses the problems and prospects of laparoscopic surgery for esophageal achalasia.