In 1913 Heller reported the first esophageal myotomy for achalasia through a left thoracotomy. Over the years, the transabdominal approach has been extensively adopted, especially in Europe. More recently, laparoscopy has emerged as the initial intervention of choice in several institutions throughout the world.
The operation consists of complete division of the two layers of esophageal muscle (longitudinal and circular fibers) and of the oblique fibers at the esophagogastric junction. A further step of the transabdominal procedure is the construction of an antireflux valve, most commonly an anterior fundoplication according to Dor.
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