Disorders of Motility

Abstract

This chapter addresses motility disorders of uncertain cause that are likely to be encountered by the general surgeon. We have included achalasia, gastroparesis and slow-transit constipation. Achalasia is caused by the loss of myenteric ganglion cells in the lower esophagus, and a similar neuropathy may also apply in at least some patients with gastroparesis and slow-transit constipation. In achalasia, options for disruption of the lower esophageal sphincter include Heller’s myotomy [usually laparoscopic], pneumatic dilatation and peroral endoscopic myotomy. Surgery does not have a major role in the management of gastroparesis or slow-transit constipation, and patients responding poorly to medical management may benefit from referral to a tertiary centre.