[Heller's extramucosal cardiomyotomy under endoscopic control. The long-term results].

Twenty-five patients underwent Heller cardiomyotomy with Nissen fundoplication, made through an abdominal incision under endoscopic control. Long term results were evaluated according to clinical, radiological, manometric and 24-hour esophageal pH-metric studies. Clinical results were excellent in 44% of the patients, good in 40%, fair in 4% and bad in 12%. The four unsatisfactory results are due to recurrence of dysphagia in one case and to appearance of GER in the others. Postoperative X-ray controls and manometric tests showed a significative decrease in the esophageal diameter, in resting and post swallowing LES and esophageal body pressure. The 24-hour pH test showed an abnormal percentage of time with pH less than 4 in two patients, and a direct connection with clinical and endoscopic results. Endoscopic control of myotomy allows us to define precisely the extension of the functional stenosis and to eliminate completely the dysphagia. In the postoperative evaluation the 24-hour pH monitoring allows an early identification of GER, and the prevention of possible complications even in the absence of any clinical sign.