Laparoscopic Heller Myotomy and Dor Fundoplication for Treatment of Achalasia

Achalasia is a degenerative esophageal disease characterized by aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter. The etiology involves T-cell mediated destruction and fibrotic replacement of the myenteric plexus, but the underlying cause remains unknown. The exact cause of achalasia is poorly understood. Researchers suspect it may be caused by a loss of nerve cells in the esophagus. There are theories about what causes this, but viral infection or autoimmune responses have been suspected. Very rarely, achalasia may be caused by an inherited genetic disorder or infection. As neural function cannot be restored, treatment is palliative, focusing on symptom control and maintaining the esophagus as a passive conduit. The primary treatment goal is to reduce lower esophageal sphincter pressure while minimizing gastroesophageal reflux, typically achieved laparoscopically via modified Heller myotomy and Dor fundoplication.