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Invited Critique
Sep 2011

Surgery for Achalasia: Is This as Good as It Gets?Comment on “Predictors of Long-term Outcome After Laparoscopic Esophagomyotomy and Dor Fundoplication for Achalasia”

Author Affiliations

Author Affiliation: Department of Surgery, University of Washington, Seattle.

Arch Surg. 2011;146(9):1028. doi:10.1001/archsurg.2011.207

The first report on a series of patients with achalasia treated using the minimally invasive approach appeared nearly 20 years ago.1 Although the operation described in that report underwent several modifications that made it more effective,2,3 the principle introduced then, minimization of access trauma, remains the same and has made surgical treatment an attractive option to patients and gastroenterologists. Dr Carter and colleagues4 now reaffirm that the operation, when performed in a center of excellence, is safe and effective and the results are durable. The information they present is more relevant today than ever, as treatments are chosen on the basis of comparative effectiveness. In that regard, the weight of the evidence today strongly favors a Heller myotomy in the management of achalasia rather than the other 3 modalities (pneumatic dilation, botulinum toxin [Botox] injection, and medical therapy).

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