In cases where the function of the esophagus body is relatively well preserved and dilation is not severe, the procedure of choice is a Heller myotomy. This operation involves longitudinal division of the circular muscle fibers of the esophagus over its lower third. Since most patients have lost their esophageal peristalsis, swallowing is primarily by gravity. Although improved, it is not normal. The functional result for most patients is good.
Surgical approaches continue to evolve and thoracoscopic techniques are playing a larger role.
Some patients present with a markedly dilated and completely non-functional esophagus. In this case, the best long term results are obtained by esophageal replacement. Use of the stomach as an esophageal replacement has yielded excellent long term results. Esophageal resection using a transhiatal approach, often termed blunt esophagectomy, is associated with lower short term mortality and reduced morbidity. A final functional abnormality of the esophagus that is amenable to surgical correction is diffuse esophageal spasm.