title: Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation.
abstract: BACKGROUND
  Although pneumatic dilatation is said to relieve dysphagia in achalasia if it decreases lower esophageal sphincter (LES) pressure to 10 mmHg (n = 23); group C, no previous balloon dilatation and LES pressure >10 mmHg (n = 25). All patients underwent a laparoscopic Heller myotomy and Dor fundoplication. The severity of dysphagia was gauged on a scale of 0-4.
  
  
  RESULTS
  In group A, LES pressure was 7 +/- 2 mmHg preoperatively and 8 +/- 3 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.9 +/- 1.1 postoperatively. Eighty-nine percent of patients had excellent or good results. In group B, LES pressure was 23 +/- 8 mmHg preoperatively and 10 +/- 1 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.3 +/- 0.5 postoperatively. All patients had excellent or good results. In group C, LES pressure was 23 +/- 11 mmHg preoperatively and 14 +/- 12 mmHg postoperatively; the dysphagia score was 3.6 +/- 0.6 preoperatively and 0.2 +/- 0.5 postoperatively. All patients had excellent or good results.
  
  
  CONCLUSIONS
  These results show that (a) a LES pressure of <10 mmHg after pneumatic dilatation does not guarantee relief of dysphagia, and (b) laparoscopic Heller myotomy relieves dysphagia in most patients with a postdilatation LES pressure <10 mmHg. Thus, a laparoscopic Heller myotomy is indicated if dilatation does not relieve dysphagia, even if LES pressure has been decreased to <10 mmHg. Esophagectomy should be reserved for the occasional failure of this simpler operation.
authors.affiliation: Department of Surgery, University of California, 533 Parnassus Avenue, San Francisco, CA 94143-0788, USA.
authors.forename: U
authors.initials: U
authors.lastname: Diener
authors.forename: M G
authors.initials: MG
authors.lastname: Patti
authors.forename: D
authors.initials: D
authors.lastname: Molena
authors.forename: A
authors.initials: A
authors.lastname: Tamburini
authors.forename: P M
authors.initials: PM
authors.lastname: Fisichella
authors.forename: K
authors.initials: K
authors.lastname: Whang
authors.forename: L W
authors.initials: LW
authors.lastname: Way
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002404:Catheterization / Q000379:methods*; D003680:Deglutition Disorders / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology / Q000601:surgery; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001466:Barium Sulfate