Figure 1: The Chicago classification for achalasia subtypes (9) Type I Achalasia with minimal oesophageal (classic) pressurisation Type II Achalasia with oesophageal compression Type III Achalasia with oesophageal spasm Figure 2: Treatment options available for the management of achalasia Pharmacological Oral nitrates (GTN, Isosorbide dinitrate) options Calcium channel blockers (Nifedipine, verapamil) Anticholinergics Opioids (loperamide) Phosphodiesterase inhibitors *2 agonists Nitric oxide agonists Endoscopic Pneumatic balloon dilatation techniques Botulinum toxin injections Peroral endoscopic myotomy (POEM) Surgical Heller's cardiomyotomy
(transabdominal or options transthoracic / open or laparoscopic)
Conclusion: Transabdominal Heller's cardiomyotomy with anterior Dor patch is a safe and effective surgical option for achalasia cardia.
Adequate cardiomyotomy remains the main principle of surgery which is often combined with fundoplication as a prophylactic anti reflux procedure6.
Selection criteria was all patients of achalasia cardia operated through abdominal approach in whom modified Heller's cardiomyotomy with anterior Dor patch was performed.
Cardiomyotomy either by transabdominal or transthoracic approach remains the basic surgical aim.
In this study we chose transabdominal modified Heller's cardiomyotomy with anterior Dor patch as the surgical treatment.
Cardiomyotomy when carried out without any fundoplication has a higher incidence of post operative reflux symptoms.
Bessel et al are proponents of laparoscopic cardiomyotomy only as an effective treatment15.
Previously esophagectomy5 was considered the only surgical treatment option for sigmoid esophagus, but now it has been shown that it can be managed successfully in selected cases with cardiomyotomy and fundoplication20.