title: [Late results of Heller operation and fundoplication for the treatment of the megaesophagus: analysis of 83 cases].
abstract: BACKGROUND
  Retrospective study of the late results of the Heller's cardiomyotomy and fundoplication for the treatment of the megaesophagus.
  
  
  METHODS
  Were studied 83 patients with a follow-up from one to 186 months (average 40.0 +/- 47.4 months). The fundoplications used were in three plans in 15.7% and posterior in 83.1%. The main pre-operatory complain was dysphagia followed by regurgitation and loss of weight. Chagas, Disease as the etiology was confirmed in 72.3% of the patients.
  
  
  RESULTS
  In the follow-up 55.4% of the patients were assymptomatic, 34.9% complained of sporadic dysphagia, 14.4% of heartburn, 8.4% of regurgitation and 2.4% did not changed the dysphagia, these being re-operated and had improvement the symptoms. Gastro-esophageal reflux was noted in 8.4% of the patients. Other late complications were par-esophageal hernia, sliping of the fundoplication, Barrett esophagus and cancer.
  
  
  CONCLUSIONS
  The necessity of a long-term clinical and endoscopical follow-up, even after surgery, owing to the possibility of late complications, especially cancer was emphasized. The late results are good in relation to the dysphagia. Myotomy is proposed as an alternative to patients with advanced megaesophagus with bad clinical conditions who can not be submitted to an esophagectomy.
authors.affiliation: Departamento de Cirurgia da Universidade Federal de São Paulo-Escola Paulista de Medicina.
authors.forename: F A
authors.initials: FA
authors.lastname: Herbella
authors.forename: J C
authors.initials: JC
authors.lastname: Del Grande
authors.forename: L G
authors.initials: LG
authors.lastname: Lourenço
authors.forename: N S
authors.initials: NS
authors.lastname: Mansur
authors.forename: C M
authors.initials: CM
authors.lastname: Haddad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome