Treatment of achalasia: esophagomyotomy with antireflux procedure.

The results of Heller myotomy with Belsey fundoplication in the treatment of 32 patients with achalasia is reviewed. Eighteen who received no previous surgical treatment had good to excellent results. Fourteen patients who had undergone previous Heller myotomy without an antireflux procedure required further surgical treatment. Inadequate myotomy and reflux esophagitis were the causes of failure. In this group four patients who were treated by myotomy, Collis gastroplasty and the Belsey procedure still failed to achieve good to excellent results. The authors conclude that gastroplasty is contraindicated in patients with achalasia.