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.