Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair

Abstract

A survey of 108 patients with achalasia treated by cardiomyotomy is reported. All the operations were done by the abdominal approach and all the patients were followed up for a minimum of 4 years. Fifty-five patients had some form of hiatal reconstruction, 11 of these having a formal plastic repair as practised for oesophageal reflux problems. At 4 years after operation 71 patients (65-5 per cent) had entirely satisfactory results. Twenty-seven patients had recurrent dysphagia and 20 patients had symptoms of reflux oesophagitis. The group who had had a formal repair of the hiatus had no reflux symptoms after operation and also had better swallowing than the other groups. These results suggest that much of the dysphagia following Heller's operation is due to occult gastro-oesophageal reflux and can be avoided by a reflux-preventing procedure. Adequate hiatal repair after myotomy is strongly recommended.

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

“…28 The mean delay in diagnosis is 5 years (range, 2-7 years). [29][30][31][32][33][34][35] Howard et al 36 reported that 36.8% of achalasia patients had been treated for GERD. Additionally, Rosenzweig and Traube 9 showed that the initial diagnosis was achalasia in only 12 of out 25 achalasia patients, whereas the other 13 patients were diagnosed incorrectly.…”

Esophagus Associated Lung Diseases- A Retrospective Study

“…Effler [16] reported pulmonary complications due to nocturnal aspirations of esophageal contents in 24 % of his subjects (n=100), 8 of them demonstrating radiologic evidence of pulmonary damage. Black et al [17] found pulmonary symptoms in 46.3 % of their 108 patients. In most of these subjectssymptom was productive cough.…”

Assessment of Gastroesophageal Reflux following Heller’s Myotomy Associated with a 270° Posterior Partial Fundoplication

“…The incidence of gastroesophageal reflux after surgery for achalasia of the cardia varies from publication to publication [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] with respect to the surgical technique, the method used to evaluate reflux and the time elapsed since operation.…”

“…One reason for the failure of surgery for achalasia of the cardia is the appearance of gastroesophageal reflux secondary to the myotomy [1][2][3][4][5][6]. This can lead to severe esophagitis with stricture due to poor 'esophageal clear ance' in these patients.…”

“…This can lead to severe esophagitis with stricture due to poor 'esophageal clear ance' in these patients. In order to avoid this burden some complication, there are currently discussions on the convenience or not of associating an antireflux pro cedure with myotomy [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], This should not be an excessive obstacle for an aperistaltic esophageal body, as it could condition dysphagia.…”