Laparoscopy or thoracoscopy for achalasia

Achalasia is an esophageal motor disorder of unknown etiology. Typical manometric findings include aperistalsis of the esophageal body coupled with elevated pressure and incomplete relaxation of the lower esophageal sphincter during swallowing. Medical treatments consist of pneumatic dilatation or injections of botulinum toxin. Surgical treatment consists of Heller's myotomy with or without an antireflux procedure. Relief of dysphagia symptoms can be achieved in 85% to 94% of patients undergoing surgical treatment. In the past decade, the minimally invasive approach for the treatment of achalasia has been proven feasible, safe, and effective. We review the role of thoracoscopy and laparoscopy and address controversies in the management of patients with achalasia.