Reoperation After Failed Esophagomyotomy for Achalasia

  • C. D. Mercer
  • L. D. Hill
Conference paper


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.


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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Vantrappen G, Hellemans J, Deloof W, Valembois P, Vabdenbrouke J (1971) Treatment of achalasia with pneumatic dilatation. Gut 12:268–275PubMedCrossRefGoogle Scholar
  2. 2.
    Ellis FH Jr, Kiser JC, Schiegel JF, Earlam RJ, McVey JL, Olsen AM (1967) Esophago-myotomy for esophageal achalasia: experimental, clinical, and manometric aspects. Ann Surg 166:640–656PubMedCrossRefGoogle Scholar
  3. 3.
    Sariyannis C, Mullard KS (1975) Oesophagomyotomy for achalasia of the cardia. Thorax 30:539–542PubMedCrossRefGoogle Scholar
  4. 4.
    Steichen FM, Heller E, Ravitch MM (1960) Achalasia of the esophagus. Surgery 47:846–876PubMedGoogle Scholar
  5. 5.
    Belsey R (1966) Functional disease of the esophagus. J Thorac Cardiovasc Surg 52:164–188PubMedGoogle Scholar
  6. 6.
    Menguy R (1971) Management of achalasia by transabdominal cardiomyotomy and fun-doplication. Surg Gynecol Obstet 133:482–484PubMedGoogle Scholar
  7. 7.
    Csendes A, Velasco N, Braghetto I, Henriquez A (1981) A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 80:789–795PubMedGoogle Scholar
  8. 8.
    Fekete F, Breil P, Tossen JC (1982) Reoperation after Heller’s operation for achalasia and other motility disorders of the esophagus: a study of eighty-one reoperations. Int Surg 67:103–110PubMedGoogle Scholar
  9. 9.
    Ellis FH Jr, Gibb SP (1975) Reoperation after esophagomyotomy for achalasia of the esophagus. Am J Surg 129:407–412PubMedCrossRefGoogle Scholar
  10. 10.
    Saubier E, Chalençon JF, Beaulieux J (1970) Réinterventions chirurgicales après opérations de Heller pour mégaoesophage essentiel (à propos de cinq observations). Lyon Med 223:883–891PubMedGoogle Scholar
  11. 11.
    Nanson EM (1966) Treatment of achalasia of the cardia. Gastroenterology 51:236–241PubMedGoogle Scholar
  12. 12.
    Patrick DL, Payne WS, Olsen AM, Ellis FH Jr. (1971) Reoperation for achalasia of the esophagus. Arch Surg 103:122–128PubMedCrossRefGoogle Scholar
  13. 13.
    Hill LD, Asplund CM, Roberts PN (1984) Intraoperative manometry: adjunct to surgery for esophageal motility disorders. Am J Surg 147:171–174PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • C. D. Mercer
    • 1
  • L. D. Hill
    • 2
  1. 1.Department of SurgeryQueen’s UniversityKingstonCanada
  2. 2.Department of SurgeryVirginia Mason Medical CenterSeattleUSA

Personalised recommendations