Heller's cardiomyotomy compared with pneumatic dilatation for treatment of oesophageal achalasia.

The records of 30 patients treated for oesophageal achalasia between 1976 and 1988 were analysed retrospectively. Early and late results were collected to compare the safety and efficacy of Heller's myotomy (n = 13) and pneumatic dilatation (n = 17). Unsatisfactory immediate postoperative results were found in 4 of 13 of the patients who had undergone myotomy (31%) and in 4 of the 17 patients treated by pneumatic dilatation (24%). More patients had improved swallowing during the first postoperative year after myotomy, but this difference ceased with time. The severity of the symptoms affected the results, and dilatations that had to be repeated more than twice were ineffective. We conclude that pneumatic dilatation is as safe as Heller's myotomy, and that although the early results are significantly better after myotomy, the late results are similar.