Management of End-stage Achalasia (Sigmoid Achalasia) with Laparoscopic Heller Myotomy

Achalasia is a rare esophageal motility disorder causing dysphagia and weight loss. Severe cases may present with a significantly dilated and sigmoid-shaped esophagus (sigmoid achalasia). Traditionally, esophagectomy was used for such cases. However, laparoscopic Heller myotomy (LHM) is emerging as a less invasive alternative with comparable outcomes. A wide dissection of the posterior mediastinum was performed to mobilize the thoracic esophagus and correct any axial rotation. The distal and proximal esophagogastric junction (EGJ) lengths were measured using a calibrated laparoscopic ruler: the distal esophageal myotomy measured nearly 8 cm, and the proximal gastric myotomy measured nearly 3.0 cm. Laparoscopic Heller myotomy with Dor's fundoplication is a promising treatment option for end-stage of achalasia, offering faster recovery and improved quality of life.