Reoperation After Failed Esophagomyotomy for Achalasia

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Abstract
Controversy surrounds the current management of patients with achalasia of the esophagus. Pneumatic dilatation of the lower esophageal sphincter or modified Heller esophagomyotomy are the two primary therapeutic modalities [1, 2]. Physicians who favor myotomy as the treatment of choice disagree on its extent [3–5] and the need for a concomitant hiatal hernia repair [5, 6]. Since there is no standard operative technique, results of individual series are difficult to compare. Most series report excellent or good results from myotomy in 90%-95% of cases [3, 7]. However, complications do occur, resulting in persistent, recurrent, or new symptoms. Knowledge of the physiology of normal esophageal function as well as the pathophysiology of the disease process are prerequisites for a proper operative approach. When reoperation is necessary this is even more important because the cause of the patient’s symptoms may be entirely different from that of the original motility disorder. We reviewed our experience with reoperative surgery after failed Heller esophagomyotomy at the Virginia Mason Medical Center in Seattle. Keywords Lower Esophageal Sphincter Lower Esophageal Sphincter Pressure Heller Myotomy Pneumatic Dilatation Esophageal Motility Disorder These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.