Normal anatomy: The esophagus carries food from the mouth to the stomach. The lower esophageal sphincter is a muscular ring at the junction of the esophagus and the stomach. The lower esophageal sphincter relaxes when food from the esophagus enters the stomach.

Indications: Achalasia is a disorder in which the lower esophageal sphincter does not relax when food passes down the esophagus to the stomach. As a result, the esophagus becomes distended and filled with food, and food passes into the stomach very slowly. Achalasia is often associated with chest pain during eating, weight loss, and regurgitation of food. The lower esophagus becomes distended as food and liquid are unable to pass into the stomach.

Procedure, part 1: Achalasia can sometimes be treated with medication that helps the lower esophageal sphincter relax. If medication is ineffective, however, esophageal dilatation can correct the problem. To open the esophagus, a balloon dilator is passed through the mouth down to the level of the lower esophageal sphincter, using an endoscope. The balloon is inflated, thus stretching the sphincter.

Incision: If achalasia recurs after balloon dilatation, surgery may be necessary to correct the defect. This surgery can often be done laparoscopically. Laparoscopic surgery involves a number of small incisions made in the upper abdomen, into which the surgeon inserts a long, thin camera and surgical instruments.

Procedure, part 2: The surgeon then makes a long incision in the esophagus at the level of the esophageal sphincter. This releases the sphincter and allows it to relax. This surgery is very effective in curing achalasia, with over 90% of patients obtaining relief from symptoms post-operatively. Recovery is generally rapid, and most patients are able to leave the hospital within 1 to 3 days. Infrequently, the operation cannot be accomplished laparoscopically, and a larger incision is required. In these cases, hopitalization times may be longer.