Surgical Treatment of Achalasia: Results with Esophagomyotomy and Belsey Repair

Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: An anti-reflux procedure is required

“…Proponents argue that a short myotomy extending just beyond the gastroesophageal junction is difficult to calibrate; too short leads to residual dysphagia and too long leads to postoperative reflux [4,20]. Meanwhile, many authors have argued against an antireflux procedure and have published admirable results to back up their position [11,14].…”

Achalasia: What’s New in Diagnosis and Treatment?

“…The modified Heller myotomy accounts for 99% of achalasia operations, at least 56% of surgeons using the transthoracic approach [213], Good to excellent results from csophaAchalasia: W hat's New in Diagnosis and Treatm ent? gomyotomy are obtained in about 90% (range 60-94%) of achalasia patients followed from 1 to 36 years [75,213,214], Esophagomyotomy lowers LES pressure more consistently than pneumatic dilatation [187,[215][216][217][218], Depending on the distal ex tent of the myotomy, LES pressure is lowered by 55-75% with the remaining residual pres sure usually being <10 mm Hg [187,[215][216][217][218], Myotomy also lowers intraesophageal pressure but does not improve LES relaxation [219]. Partial return of peristalsis is reported in up to 14% of patients after myotomy, but these are usually manometric reports without correlation with barium clearance [199,[220][221][222].…”

“…Finally. (4) pneu matic dilatation does not hinder the perfor mance of a future myotomy [218], Pneumatic dilatation can be done safely and successfully in any age group (infants to 90 years of age), and during pregnancy [145. 243, 244], Some Dig Dis 1997:15<suppl I ): I -27experts consider the presence of a hiatal her nia or cpiphrenic diverticulum as a relative contraindication to pneumatic dilatation due to a higher risk of perforation, however suc cessful dilatations are reported [245,246].…”

Surgical solutions for esophageal dysphagia

“…This is often referred to as a modified Heller procedure. Using this approach they report good to excellent relief of dysphagia in 88% of patients, an operative mortality rate of 1.8%, and no acid reflux as measured by pH reflux testing [ 12].…”