Minimally invasive surgery for esophageal achalasia

Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallow- ing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the fi rst-line therapeutic approach. In this editorial, the rationale and the evidence supporting the use of laparoscopic Hel- ler myotomy combined with fundoplication as a primary treatment of achalasia are reviewed.