Reoperation after Heller's operation for achalasia and other motility disorders of the esophagus: a study of eighty-one reoperations.

Most failures or pseudo-failures of Heller's operation are due to an imperfect surgical technique. The procedure should include the entire muscular layer, extend as far upwards as possible and at least two to three cm downwards onto the stomach. Furthermore, it should be associated with an anti-reflux procedure. Eighty-one operations were performed in 70 patients who had previously undergone Heller's operation. Of the 42 patients presenting with recurrent achalasia, 21 had an insufficient Heller procedure upwards, 10 downwards and 11 in depth. Twenty-three patients had peptic esophagitis and three had periesophageal sclerosis. The management of these 70 reoperated patients included 36 iterative esophageal myotomies, 32 resections, four total duodenal diversions and two hiatal reconstructions. Repeated cardiomyotomies gave excellent results in 75% of cases and esophagogastric resection in 79%.