Skip to main content
SpringerLink
Log in

The surgical management of motility disorders

  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Surgical treatment is either the therapy of choice or a facultative procedure in various types of esophageal motility disorders. In achalasia, cardiomyotomy, frequently combined with fundoplasty, achieves good or excellent results in >80% of cases, and is, therefore, advised in cases when pneumostatic dilatation fails. Diverticulectomy and myotomy of the upper or lower esophageal sphincter are proven procedures to treat cervical and epiphrenic diverticula, leading to good/excellent results or at least an improvement in more than 95%. If, exceptionally, parabronchial diverticula require therapy, they should be excised transthoracically. Cervical myotomy is indicated in cases of cervical achalasia, when sufficient pharyngeal propulsion is preserved. In systemic diseases like scleroderma reflux induced complications may require surgical intervention in medically intractable cases. In these rather few cases, subtotal gastrectomy with a Roux-en-Y anastomosis is advised. In patients suffering from diffuse esophageal spasm or symptomatic “nutcracker” esophagus, extended esophageal myotomy can relieve symptoms. If a clear diagnosis is provided, about 75% of patients will have an improvement of symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vantrappen G, Hellemans J: Treatment of achalasia and related motor disorders.Gastroenterology 79:144–154, 1980

    Google Scholar 

  2. Bortolotti M, Labo G: Clinical and manometric effects of nifedipine in patients with esophageal achalasia.Gastroenterology 80:39–44, 1981

    Google Scholar 

  3. Gelfond M, Rozen P, Keren S, Gilat T: Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid.Gut 22:312–318, 1981

    Google Scholar 

  4. Traube M, Henger M, Magyar L: Effects of nifedipine in achalasia and in patients with high amplitude peristaltic esophageal contractions.JAMA 252:13 1733, 1984

    Google Scholar 

  5. Weiser HF, Lepsien G, Golinkofer K, Siewert R: Clinical and experimental studies on the effect of nifedipine on smooth muscle of the esophagus and LES. In: Duthie HL (ed.):Gastrointestinal Motility in Health and Disease. Lancaster: MTP Press, 1978, pp 565–572

    Google Scholar 

  6. Traube M, Dubovik S, Lange RC, McCallum RW: The role of nifidipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study.Am J Gatroenterol 2:84(10) 1259–1262, 1989

    Google Scholar 

  7. Triadofilopoulos G, Aaronson M, Sackel S, Burakoff R: Medical treatment of esophageal achalasia: double-blind crossover study with oral nifedipine, verapamil, and placebo.Dig Dis Sci 36(3):260–267, 1991

    Google Scholar 

  8. Fournet J: Medical treatment of achalasia: What is the effect of medical treatment on the different stages of the disease? In: Giuli R, McCallum RW, Skinner DB (eds.):Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 382–383

    Google Scholar 

  9. Barkin JS, Gudrud M, Reiner DK, Goldberg RI, Phillips RS: Forceful balloon dilatation: an outpatient procedure for achalasia.Gastrointest Endosc 36:123–126, 1990

    Google Scholar 

  10. Fellow IW, Ogilvie AL, Atkinson M: Pneumatic dilatation in achalasia.Gut 24:1020–1023, 1983

    Google Scholar 

  11. Bennett JR, Hendrix TR: Treatment of achalasia with pneumatic dilatation.Mod Treat 7:1217–1228, 1970

    Google Scholar 

  12. Wienbeck M, Heitmann P: Die pneumatische Dilatation zur Behandlung der Achalasie der Speiseröhre.Dtsch Med Wochenschr 98:814–825, 1973

    Google Scholar 

  13. Heimlich HJ, O'Connor TW, Flores DC: Case for pneumatic dilatation in achalasia.Ann Otol 87:519–522, 1978

    Google Scholar 

  14. Lishmann AH, Dellipiani AW: Management of achalasia of the cardia by forceful pneumatic dilatation.Gut 23:541–544, 1982

    Google Scholar 

  15. Robertson CS, Fellows IW, Mayberry JR, et al: Choice of therapy for achalasia in relation to age.Digestion 40:244–250, 1988

    Google Scholar 

  16. Csendes A, Velasco N, Braghetto I, et al: A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus.Gastroenterology 80:789–795, 1981

    Google Scholar 

  17. Csendes A, Braghetto I, Henriquez A, et al: Late results of a prospective study comparing forceful dilatation and esophagomyotomy in patients with achalasia.Gut 30:299–304, 1989

    Google Scholar 

  18. Vantrappen G: How often does conservative treatment of perforation after pneumatic dilatation result in healing? In: Giuli R, McCallum RW, Skinner DB (eds.):Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 398–399

    Google Scholar 

  19. Sanderson DR, Ellis FH Jr, Olsen AM: Achalasia of the esophagus: results of therapy with dilatation.Chest 58:116

  20. Isolauri J, Feussner H, Hölscher AH, Siewert JR:Pneumatic Dilatation and Cardiomyotomy with Modified Thal Fundoplasty in the Treatment of Achalasia of the Esophagus. In: Little AG, Ferguson MK, Skinner DB (eds.): Mount Kisco, New York: Futura Publishing, 1990, pp 299–304

    Google Scholar 

  21. Cohen NN: An end point for pneumatic dilatation of achalasia.Gastrointest Endosc 22:29, 1975

    Google Scholar 

  22. Boyce HW: How long should dilatation be continued? In: Giuli R, McCallum RW, Skinner DB (eds.):Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1992, pp 396–398

    Google Scholar 

  23. Belsey R: Functional disease of the esophagus.J Thorac Cardiovasc Surg 52:164–168, 1966

    Google Scholar 

  24. Ellis FH, Crozier RE, Watkins E: Operations for esophageal achalasia.Cardiovasc Surg 88:344–351, 1984

    Google Scholar 

  25. Andreollo NA, Earlam RJ: Heller's myotomy for achalasia: Is an added antireflux procedure necessary?Br J Surg 74:765–769, 1987

    Google Scholar 

  26. Murray GF, Battoglini JW, Keagy BA, Starck PJK, Wilcox BR: Selective application of fundoplication in achalasia.Ann Thorac Surg 37:185–188, 1983

    Google Scholar 

  27. Ricci C, De Giacomo T: The anti-reflux procedures associated with myotomy. In: Giuli R, McCallum RW, Skinner DB (eds.):Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 491–493

    Google Scholar 

  28. Crookes PF, Wilkinson AJ, Johnston GW: Heller's myotomy with partial fundoplication. Br J Surg 76:98–99, 1989

    Google Scholar 

  29. Stipa S, Fegiz G, Jascone C, Paolini A, Moraldi A, DeMarchi C, Chieco PA: Heller-Belsey and Heller-Nissen operations.Surg Gynecol Obstet 170:212–216, 1990

    Google Scholar 

  30. Paricio PP, Martinez DE, Haro L, Ortiz A, Aguyayo JL: Achalasia of the cardia: long-term results of oesophagectomy and posterior partial fundoplication.Br J Surg 77:1371–1374, 1990

    Google Scholar 

  31. DeMeester TR, Stein HJ: Surgery of esophageal motor disorders. In: Castell DO (ed.):The Esophagus. Boston: Little Brown and Company, 1992, pp 401–440

    Google Scholar 

  32. Barthlen W, Feussner H, Hannig C, Hölscher AH, Siewert JR: Surgical therapy of Zenker's diverticulum: low risk and high efficiency.Dysphagia 5:13–19, 1990

    Google Scholar 

  33. Hauters P, Segol P, Leroux Y, Ginoux M: Place de la myotomie du crico-pharyngien associé à une diverticulopexie dens le traitement du diverticule de Zenker.Ann Chir 42(10):726–730, 1988

    Google Scholar 

  34. Orringer MB: Extended cervical esophagectomy for cricopharyngeal dysfunction.J Thorac Cardiovasc Surg 80:669–768, 1980

    Google Scholar 

  35. Huang B, Payne WS, Cameron AJ: Surgical management for recurrent pharyngoesophageal (Zenker's) diverticulum.Ann Thoraca Surg 37:189–191, 1984

    Google Scholar 

  36. Skinner DB, Altorki N, Ferguson M, Little G: Zenker's diverticulum: clinical features and surgical management.Dis Esoph 1(1):19–21, 1988

    Google Scholar 

  37. Payne WS, Reynolds RR: Surgical treatment of pharyngoesophageal diverticulum (Zenker's diverticulum).Surg Rounds 5(6):18–24, 1982

    Google Scholar 

  38. Belsey RH: Myotomy combined with diverticulopexy. In: Guili R, McCallum RW, Skinner DB (eds.): Primary motility disorders of the esophagus. Paris: John Libbey Eurotext, 1991, pp 900–901

    Google Scholar 

  39. Dohlmann G, Mattson O: The endoscopic operation for hypopharyngeal diverticula.Arch Otolaryng 71:744–752, 1960

    Google Scholar 

  40. Knegt PP, de Jong PC, Van der Schans EJ: Endoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser.Endoscopy 17:205–206, 1985

    Google Scholar 

  41. Van Overbeek JJM, Hoeksema PE: Endoscopic treatment of the hypopharyngeal diverticulum: 211 cases.Laryngoscope 92:88–91, 1982

    Google Scholar 

  42. Del Genio A, Amato G, Napolitano V, Maresca M, Allaria A, Nuzzuo A: What are the indications for endoscopic methods of treatment? In Giuli R, McCallum RW, Skinner DB (eds.):Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 879–881

    Google Scholar 

  43. Feussner H, Siewert JR: Zenker's diverticulum and reflux.Hepatogastroenterology 39:100–103, 1992

    Google Scholar 

  44. Luckhaupt H, Rose KG: Behandlung und Behandlungsergebnisse beim Zenker'schen Divertikel.HNO 32:35–37, 1984

    Google Scholar 

  45. Holinger PH, Schild JA: The Zenker's (hypopharyngeal) diverticulum.Ann Otol Rhinol Laryngol 78:679–688, 1969

    Google Scholar 

  46. Trastek VF, Payne WS: Esophageal diverticula. In: Shields TW (ed.):General Thoracic Surgery, 3rd ed. Philadelphia: Lea and Febiger, 1989

    Google Scholar 

  47. Debas HT, Payne WS, Cameron AJ, Carlson HC: Physiopathology of lower esophageal diverticulum and its implications for treatment.Surg Gynecol Obstet 151:593–603, 1980

    Google Scholar 

  48. Ishigami K, Matsuo Y, Yamane M, Suzuki H: Surgical treatment of diverticula of the midthoracic esophagus with special reference to their pathogenesis.Arch Jpn Surg 34:509–523, 1965

    Google Scholar 

  49. Belsey RH: Functional disease of the esophagus.J Thorac Cardiovasc Surg 52:164–188

  50. Kaye MD: Esophageal motor dysfunction in patients with diverticula of the mid-thoracic esophagus.Thorax 29:666–671, 1974

    Google Scholar 

  51. DeMeester TR: Surgical therapy of esophageal motility disorders. In: Fuchs KH, Hamelman H (eds.):Gastrointestinale Funktionsdiagnostik in der Chirurgie. Berlin: Blackwell-Verlag, 1991, pp 99–118

    Google Scholar 

  52. Feyiz G, Paolin A, De Marchi C, Tosato F: Surigical management of esophageal diverticula.World J Surg 8:757–765, 1984

    Google Scholar 

  53. Duranceau AC: Diverticula of the oesophageal body. In: Jamieson GG (ed.): Surgery of the oesophagus. Edinburgh: Churchill Livingstone 1988, pp 489–500

    Google Scholar 

  54. Duranceau A, Lafontaine ER, Taillefer R, Jamieson GG: Oropharyngeal dysphagia and operations on the upper esophageal sphincter.Ann Surg 19:317–362, 1987

    Google Scholar 

  55. Ross ER, Green R, Auslander MO, Biller HF: Cricopharyngeal myotomy: management of cervical dysphagia.Otolaryngol Head Neck Surg 90:434–442, 1982

    Google Scholar 

  56. Berg HM, Persky MS, Jacobs JB, Cohen NL: Cricopharyngeal myotomy: a review of surgical results in patients with cricopharyngeal achalasia of neurogenic origin.Laryngoscope 95:1337–1340, 1985

    Google Scholar 

  57. Bonavina L, Khan NA, DeMeester TR: Pharyngoesophageal dysfunctions. The role of cricopharyngeal myotomy.Arch Surg 120:541–549, 1985

    Google Scholar 

  58. Brindley GV, Texter EG: Scleroderma of the esophagus: medical and surgical management.Texas Med 68:74–80, 1972

    Google Scholar 

  59. Henderson RD, Pearson FC: Surgical management of esophageal scleroderma.J Thorac Cardiovasc Surg 66:689–691, 1973

    Google Scholar 

  60. Orringer MB, Orringer JS, Dabich J, Zarafernetis CJ: Combined Collis gastroplasty—fundoplication operations for scleroderma reflux esophagitis.Surgery 90:624–630, 1981

    Google Scholar 

  61. Siewert JR, Feussner H: Motility disorders of the oesophagus. Collagen diseases. In: Jamieson GG (ed.):Surgery of the Oesophagus. Edinburg: Churchill Livingstone, 1988, pp 501–510

    Google Scholar 

  62. Eason RJ, Tan PL, Gow PJ: Progressive systemic sclerosis in Auckland: a ten-year review with emphasis on prognostic features.Aust NZ 1 Med 11:657–662, 1981

    Google Scholar 

  63. Garrett JM, Winckelmann RK, Schlegel JF, Code CF: Oesophageal deterioration in scleroderma.Mayo Clin Proc 46:92–96, 1971

    Google Scholar 

  64. Henderson RD, Ryder D, Marryatt G: Extended esophageal myotomy and short total fundoplication hernia repair in diffuse esophageal spasm: five-year review in 34 patients.Ann Thorac Surg 43:25–31, 1987

    Google Scholar 

  65. Leonardi HK, Shea JA, Crozier RE, Ellis FH Jr: Diffuse spasm of the esophagus: clinical, manometric and surgical considerations.J Thorac Cardiovasc Surg 74:736–743, 1977

    Google Scholar 

  66. Ellis FH Jr, Crozier RE, Shea JA: Long esophagomyotomy for diffuse esophageal spasm and related disorders. In: Siewert JR, Hölscher AH (eds.):Diseases of the Esophagus. Berlin: Springer-Verlag, 1988, pp 913–917

    Google Scholar 

  67. Ferguson TB, Woodbury JD, Roper CL: Giant muscular hypertrophy of the esophagus.Ann Thorac Surg 8:209, 1969

    Google Scholar 

  68. Flye MW, Sealy WC: Diffuse spasm of the esophagus.Ann Thorac Surg 19:677, 1975

    Google Scholar 

  69. Stein HJ, DeMeester TR: What is the success rate with surgical therapy? In: Guili R, McCallum RW, Skinner DB (eds.):Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991 pp 732–733

    Google Scholar 

  70. Benjamin SB, Gerhardt DC, Castell DO: High amplitude peristaltic esophageal contractions associated with chest pain. and/or dysphagia.Gastroenterology 77:478–483, 1979

    Google Scholar 

  71. Traube M, Albibi R, McCallum RW: High amplitude peristaltic esophageal contractions associated with chest pain.JAMA 250:2655–2659, 1983

    Google Scholar 

  72. Herrington JP, Burns TW, Balart LA: Dysphagia in patients with prolonged peristaltic contractile duration of the esophagus.Dig Dis Sci 29:134–140, 1984

    Google Scholar 

  73. Brand DL, Martin D, Pope CE II: Esophageal manometrics in patients with angina-type chest pain.Am J Dig Dis 23:300–304, 1977

    Google Scholar 

  74. Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing in patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients.Ann Intern Med 106:593–597, 1987

    Google Scholar 

  75. Horton ML, Goff JS: Surgical treatment of nutcracker esophagus.Dig Dis Sci 31:878–883

  76. Richter JE, Castell DO: Surgical myotomy for nucracker esophagus. To be or not to be?Dig Dis Sci 32(1):95–96, 1987

    Google Scholar 

  77. Traube M, Tummala V, Baue A, McCallum RW: Surgical myotomy in patients with high-amplitude peristaltic esophageal contractions. Manometric and clinical effects.Dig Dis Sci 32(1):16–21, 1987

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Technischen Universität München, Ismaninger Straße 22, 8000, München 80, Germany

    H. Feussner MD, W. Kauer MD & J. R. Siewert MD

Authors
  1. H. Feussner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Kauer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. R. Siewert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feussner, H., Kauer, W. & Siewert, J.R. The surgical management of motility disorders. Dysphagia 8, 135–145 (1993). https://doi.org/10.1007/BF02266994

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02266994

Key words

Search

Navigation