An operation called a Fundioplication is able to correct the problem of acid wash into the esophagus. The technique can be performed scopically and certain techniques are employed such as the nissen fundioplication. An example of the Laparoscopic Nissen Fundoplication Surgery Procedure can be seen at: http://www.or-live.com/tgh/1332/ Achalasia or acalasia is a failure of a ring of muscle (as a sphincter) to relax (completely). ...
A neurogenic esophageal disorder of unknown cause characterized by impaired esophagealperistalsis and a lack of loweresophagealsphincter relaxation.
In achalasia, loweresophageal resting pressure is increased and intraesophageal pressure is increased relative to gastric pressure.
A modified Heller's procedure (anterior myotomy of the circular muscle fibers of the loweresophagealsphincter, preserving the sphincter competency) is successful in 80 to 90% of patients.
The main problem until recent years was to demonstrate an anatomical structure on distal esophagus that matched to the classical concept of a sphincter, that is, a distinct ring of a thickened circular muscle separated from the adjoining muscles by connective tissue septums [1, 5].
Winans challenged the classic concept of a circular sphincter in 1977, when he demonstrated a manometric asymmetry of the loweresophagealsphincter (LES) [6].
A recent study has shown that the manometric three-dimensional pressure images of the loweresophageal high-pressure zone correlates with the radial and longitudinal asymmetry of muscular structures at the GEJ [8].
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