Abstract
After a wide revision of the Literature, the most frequent causes of failure in the surgical therapy of esophageal achalasia are described. Above all there is the uncorrect execution of the Heller's myotomy as for its upward and downward extension or its deepness. An uncorrect myotomy, in fact, might cause the persistence or relapse of pre-operative symptoms, such as dysphagia and regurgitation. A correct myotomy, according to the authors, should be always carried out with the aid of intraoperative manometry (IEM), which allows the documentation of the alterations caused by surgery in the area of the high pressure zone, which corresponds to the sphincter (LES). A correct myotomy must produce the complete annulment of such a pressure. This technique creates the conditions sufficient to the genesis of gastroesophageal reflux (GER), which is one of the most frequent causes of failure in the surgery of achalasia. In fact, it causes a reflux esophagitis which can quickly evolve into a stricture with the reappearance of dysphagia. It is essential, therefore, to combine always the Heller's procedure with an antireflux procedure, which can protect the esophagus from GER and at the same time does not produce a mechanical obstacle to deg...Continue Reading