Intraoperative esophageal manometry in surgical treatment of achalasia: a reappraisal.
OBJECTIVE
Intraoperative Esophageal Manometry is used during surgery for gastroesophageal reflux disease to obtain a better lower esophageal sphincter pressure, or during the Heller procedure for achalasia to verify the myotomy. The effectiveness of this manometry is not explicit.


METHODS
From 1977 to 1987, 58 patients underwent surgery for achalasia at our Institution. A transabdominal Heller's myotomy and a modified Dor's anterior fundoplication were performed in all cases. During the operation, Lower Esophageal Sphincter Pressure was measured in 38 patients (A group) to verify the completeness of the càr-diomyotomy; the fundoplication-induced pressure increase was also recorded. Twenty patients (B group) underwent surgery without intraoperative manometry. Forty-six patients (30 of A group and 16 of B group) were followed up for 24 to 120 months (median 68 months) by means of a clinical questionnaire, barium meal, manometry and 24-hour esophageal pH monitoring.


RESULTS
In 21 cases, intraoperative manometry showed the completeness of the myotomy at the first record, while in the remaining 17 it revealed the persistence of a High Pressure Zone; in these, a more accurate incision of the muscle layers on the anterior surface of the esophagus was subsequently performed up to a complete abolition of the HPZ. Long-term results were excellent or good in 27 (90%) patients of A group and in 9 (56%) patients of B group. Dysphagia and gastro-esophageal reflux were the commonest findings in patients with poor results.


CONCLUSIONS
The usefulness of intraoperative manometry in the surgical treatment of achalasia is emphasized and some technical details are reported.
Clemente
G
G
Department of Surgery, Catholic University of Sacred Heart, Agostino Gemelli Medical School-Rome, Italy.
D'Ugo
D
D
Granone
P
P
Nuzzo
G
G
Picciocchi
A
A
D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008365:Manometry; D016896:Treatment Outcome