Background: Achalasia is a progressive motility disorder of the esophagus, without a definitive cure.
The principal method of palliation is myotomy of the distal esophagus. We analyzed the 5-year experience
at our institution with laparoscopic Heller myotomy without an antireflux procedure to
determine its results, particularly regarding postoperative gastroesophageal reflux.
Materials and Methods: Thirty-three patients, mean age 43 years (range, 29–62 years) with clinical,
manometric, x-ray, and endoscopic proof of achalasia were operated on and followed up for 24
months. Prior to being referred to surgery they had all undergone at least one pneumatic balloon
dilation. The operative technique was a 7-cm myotomy that included the lower esophageal sphincter
but did not exceed 5 mm of the gastric cardia. Follow-up consisted of clinical observation, cineesophagography,
and 24-hour pHmetry.
Results: All patients reported satisfactory to excellent results regarding dysphagia and no heartburn
two years after the operation. The 24-hour pHmetry and the radiographic investigation showed
no evidence of gastroesophageal reflux.
Conclusion: It seems that the risk of gastroesophageal reflux is very low when the cardiomyotomy
does not exceed the length of 5 mm. Our results are in accordance with other observational studies
as well as larger cohort and meta-analysis studies. Prospective randomized studies are needed to
clarify the role of an antireflux procedure after laparoscopic Heller myotomy.
