Ernst Heller and the surgical treatment of esophageal achalasia

Authors

DOI:

https://doi.org/10.37085/AvanMed.74

Keywords:

surgical myotomy, History, surgery, Achalasia, 20 th century

Abstract

The therapeutic approach to achalasia, whether idiopathic or secondary to Chagas disease has undergone significant transformation in recent decades. Initially performed via laparotomy, the procedure transitioned to laparoscopic techniques during the late twentieth century and is now increasingly performed through peroral endoscopic myotomy (POEM). Brazilian surgical groups have garnered considerable expertise in this minimally invasive modality, owing to the high prevalence of chagasic megaesophagus in the region. At the core of this therapeutic paradigm lies the legacy of Ernst Heller, a distinguished German surgeon born in Dębice, West Prussia, whose innovative technique revolutionized the management of the disease. Operating within the constraints of early 20th-century medicine, Heller nonetheless achieved remarkable clinical success. His index patient demonstrated immediate postoperative tolerance to solid foods and maintained excellent functional outcomes thereby establishing a pivotal contribution to esophageal surgery. Heller's legacy persists, as the myotomy bearing his name remains a cornerstone of contemporary therapeutics. This work aims to present a comprehensive biographical overview of Ernst Heller and his seminal contributions to the surgical treatment of achalasia.

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References

1. History of community - Dębica [Internet]. Virtual Shtetl. Warsaw: POLIN Museum of the History of Polish Jews; c2026 [cited 2026 Jan 8]. Available from: https://sztetl.org.pl/en/towns/d/202-debica/99-history/137234-history-of-community

2. Local history - Dębica [Internet]. Virtual Shtetl. Warsaw: POLIN Museum of the History of Polish Jews; c2026 [cited 2026 Jan 8]. Available from: https://sztetl.org.pl/en/towns/d/202-debica/96-local-history/66790-local-history

3. Steichen FM, Ravitch MM. Ernst Heller, M.D., 1877-1964. NY State J Med. 1965;65:250-2.

4. Andreollo NA, Lopes LR, Malafaia O. Heller's myotomy: a hundred years of success! Arq Bras Cir Dig. 2014 Jan-Mar;27(1):1-2. doi: 10.1590/s0102-67202014000100001.

5. Payne WS. Heller's contribution to the surgical treatment of achalasia of the esophagus. 1914. Ann Thorac Surg. 1989 Dec;48(6):876-81. doi: 10.1016/0003-4975(89)90695-4.

6. Heller E. Extramuköse cardiaplastik beim chronischen cardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir. 1914;27:141-9.

7. De Bruine Groeneveldt JE. Over cardiospasme. Ned Tijdschr Geneeskd 1918;54(Sect 2):1281-2

8. Zaaijer, J. H. (1923). Cardiospasm in the aged. Annals of Surgery, 77(5), 615-617.

9. Andreollo NA, Earlam RJ. Heller's myotomy for achalasia: is an added anti-reflux procedure necessary? Br J Surg. 1987;74:765-9. doi: 10.1002/bjs.1800740903.

10. Fisichella PM, Patti MG. From Heller to POEM (1914-2014): a 100-year history of surgery for Achalasia. J Gastrointest Surg. 2014 Oct;18(10):1870-5. doi: 10.1007/s11605-014-2547-8.

11. Pinotti HW, Gama-Rodrigues JJ, Ellenbogen G, Arab-Fadul R, Raia A. New basis for the surgical treatment of megaesophagus: esophagocardiomyotomy with esophagus-fundus-gastropexy. AMB Rev Assoc Med Bras. 1974;20(9):331-4.

12. Chadu Junior JB, Oliveira JA, Faion AG, Zilberstein B. Short and long-term results of laparoscopic esophagocardiomyotomy with fundoplication (heller-pinotti surgery) in the treatment of non-advanced achalasia (megaesophagus). Arq Bras Cir Dig. 2024 Jun 17;37:e1803. doi: 10.1590/0102-6720202400010e1803

13. Barron JO, Toth AJ, Blackstone EH, Ramji S, Jain N, Tasnim S, Thota PN, Gabbard SL, Zanoni A, Sudarshan M, Murthy SC, Raja S; Cleveland Clinic Esophageal Research Group. Heller myotomy for esophageal achalasia: Outcomes in 1010 patients with longitudinal follow-up. J Thorac Cardiovasc Surg. 2025 Dec;170(6):1821-1830.e4. doi: 10.1016/j.jtcvs.2025.06.011. Epub 2025 Jun 18. PMID: 40541734.

14. Milone M, Manigrasso M, Vertaldi S, Velotti N, Aprea G, Maione F, Gennarelli N, De Simone G, De Conno B, Pesce M, Sarnelli G, De Palma GD. Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis. Dis Esophagus. 2019 Dec 13;32(10):1-8. doi: 10.1093/dote/doz062. PMID: 31274153..

15. Fukushima N, Masuda T, Tsuboi K, Watanabe J, Yano F. Long-term outcomes of treatment for achalasia: Laparoscopic Heller myotomy versus POEM. Ann Gastroenterol Surg. 2024;8(5):750-60.

16. Aiolfi A, Damiani R, Manara M, Cammarata F, Bonitta G, Biondi A, Bona D, Bonavina L. Robotic versus laparoscopic heller myotomy for esophageal achalasia: an updated systematic review and meta-analysis. Langenbecks Arch Surg. 2025 Feb 17;410(1):75. doi: 10.1007/s00423-025-03648-1. PMID: 39961886; PMCID: PMC11832576..

17. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010 Apr;42(4):265-71. doi: 10.1055/s-0029-1244080. Epub 2010 Mar 30. PMID: 20354937.

18. Seng W. Cirurgia do esophago. Bol Soc Med Cir São Paulo. 1922;5:128-33.

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Published

2026-01-30

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HISTÓRIA DA MEDICINA

How to Cite

Miranda, L. E. C., Tenorio, S. C., & Miranda , A. C. (2026). Ernst Heller and the surgical treatment of esophageal achalasia. Avanços Em Medicina, 6(1). https://doi.org/10.37085/AvanMed.74