[Surgical treatment of failures or recurrences after Heller cardiomyotomy (author's transl)].

A Heller cardiomyotomy has been realized in 406 cases of achalasia. The indications for operation are defined. Surgery must be preferred to dilatation: the results are favorable in 96% of cases. The failures or so-called failures are detailed. In failures or recurrences due to an insufficient cardiomyotomy, a new myotomy is indicated. Gastro-esophageal reflux is frequently an indication for oesogastric resection. Failures have been observed in 70 cases. The insufficient initial myotomy was completed in 36 cases. The etiology of postmyotomy sclerosis (15 perioesophageal, 3 interstitial) is discussed. Severe peptic oesophagitis, observed in 15 cases, stresses the importance of restoring the anti-reflux mechanism, rather than using a thoracic approach with the risk of a myotomy too limited towards the stomach. Other causes of failures (atypical mega-oesophagus, limited peptic stenosis) are due to an erroneous interpretation of preoperative X-rays, endoscopy and manometric data: in such cases, the original treatment should have been adapted to the lesion. Finally, 8 postoperative oesophageal asystolias and 4 cancers stress the importance of an early myotomy, correctly realized through an abdominal approach.