Efficacy and safety of cardiomyotomy in patients with achalasia after failure of pneumatic dilatation.

摘要: In patients with achalasia, it has beensuggested that pneumatic dilatation could makecardiomyotomy more difficult to perform, diminishing itsefficacy and safety. Our aim was evaluate theefficacy safety of elective cardiomyotomy afterfailure in achalasia. During 14years, 32 276 consecutive achalasiahave been operated on because failure therapy. Twenty have followed-upfor at least one year after surgery. After ofdilatation, Heller's 180 anteriorfundoplication were performed. Clinical status evaluated before Loweresophageal sphincter pressure esophageal body basalpressure measured by manometry, diameterby barium meal, gastroesophageal reflux endoscopy 24-hr pH monitoring.No technical difficulties found during operation.Postoperative morbidity infrequent mortality wasabsent. Cardiomyotomy improved clinical 19 20 patients. The results surgerywere considered excellent or good 16 (80%;CI: 56-94%). the lower esophagealsphincter significantly reduced, falling most under 10 mm Hg. Gastroesophagealreflux appeared surgery eight patients, four ofthem endoscopic esophagitis, but controlledin all medical conclusion, is a safe effective therapyin achalasia failed pneumaticdilatation.