Patients who choose surgery as their initial intervention, or who fail dilatation, should be referred to a surgeon with substantial experience in the field of esophageal surgery. Both the length of the myotomy and the performance of the fundoplication seem to be more of an art than a science. Experience and past results are very important for outcomes. Because of the shorter recovery times, I generally send patients to someone experienced in minimally invasive surgery for achalasia. At our institution, this has been a laparoscopic surgeon. In others, thoracoscopic surgeons appear to dominate. I do not think there is convincing evidence in favor of one over the other. Should a follow-up surgery be required because of bad results, we have tended to favor an open procedure on the grounds that the second surgery should have the best exposure possible in what may be the last good chance at surgical correction. However minimally invasive surgery for failed myotomies have been described.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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