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Updated: Aug 23, 2026

Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia
Published on: February 16, 2024
Surgical treatment of achalasia: current status and controversies
Farshad Abir1, Irvin Modlin, Mark Kidd
1Department of Surgery, Yale University School of Medicine, New Haven, Conn. 06520-8062, USA.
Objective:
To review the current management of achalasia, and the controversies regarding the different treatment options.
Methods:
A review of the literature was performed. The key words used were esophageal achalasia, Heller myotomy, endoscopic balloon dilatation, laparoscopic Heller myotomy, and fundoplication.
Results:
Patients who fail medical therapy (e.g. pharmacologic therapy, botulinum toxin, balloon dilatation) should be considered for surgical therapy for the management of achalasia. Currently, numerous surgical procedures exist for the treatment of achalasia (transabdominal cardiomyotomy, thoracoscopic or open transthoracic cardiomyotomy, and laparoscopic Heller myotomy with an antireflux procedure).
Conclusions:
Laparoscopic Heller myotomy is generally accepted as the operative procedure of choice for achalasia. However, controversy exists as to whether a concomitant antireflux procedure is necessary, and if so, what type should be performed. Given the deleterious effects of postoperative reflux, and the facility of including an antireflux procedure at the time of the myotomy, there is merit in undertaking an antireflux procedure at the time of the laparoscopic Heller myotomy.
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