Ernst Heller and the surgical treatment of esophageal achalasia

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.