[Achalasia: botulinus toxin, interventional balloon dilatation, myotomy?]

67 patients with achalasia were treated either medically, endoscopically or surgically from 1987 to 1997 in the Department of Surgery of the University of Tübingen. 27/67 (40%) of the patients, who were pneumatically dilatated, had a very successful therapy within the first year after dilatations. 12/67 (17%) of the patients had good results with a dysphagia score less than 1 after dilatations within the first year. The perforation rate of interventionally treated patients was 1.4% without any surgical procedure. Open myotomy according to Heller was performed in 28 of 67 patients (41%); after 1993 a laparoscopic procedure was performed in all patients. The average hospitalization for MIC was 5.4 days. The manometric control investigations showed a decrease of the basal LES pressure from preoperative values. When evaluated manometrically 87% showed good results in the follow up time of at least 24 months. 14% of those who underwent surgery had to be endoscopically dilatated after surgery.