Approaches and Surgical Techniques for Esophageal Achalasia, Hiatal Hernia and GERD (Gastro-Esophageal Reflux Disease)

Abstract

For Achalasia a myotomy, which had been initially developed by Heller more than hundred years ago, is an effective therapy with good long-term results. Both abdominal and thoracic (minimally-invasive) approaches have been developed and improved the morbidity significantly. With the peroral endoscopic myotomy (POEM) an innovative, endoscopic therapy evoked using a completely different access to the muscle layer of the distal esophagus. Instead of fearing a competition the surgeon should accept the new therapy, but should also know its limitations. Long-term results of the POEM procedure are still rare in the current literature. For the anti-reflux surgery both pharmaceutic, transabdominal (laparoscopic) and thoracic approaches exist, which have individual indications and require a permanent learning within the field of functional surgery. Over the past years endoscopic techniques evoked and developed to a new column of anti-reflux treatment.