OBJECTIVE: To assess the causes of failure of laparoscopic Heller myotomy and to verify whether endoscopic @entity384 is a feasible treatment. SUMMARY BACKGROUND DATA: Laparoscopic Heller myotomy has proved an effective treatment for @entity1318 , with good or excellent results in 90% of @entity1 . The treatment of failures remains controversial, however. METHODS: From 1992 to 1999, 113 @entity1 underwent laparoscopic Heller myotomy for @entity1318 . Ten @entity1 (8.7%) reported @entity1282 (n = 7) or @entity662 (n = 3) a median of 5 months after surgery (range 1-12) and were considered surgical failures. Pre- and postoperative radiologic, manometric, and 24-hour pH monitoring findings in @entity1 with @entity1318 recurrence were compared with those of 74 asymptomatic subjects. RESULTS: The preoperative characteristics of the two groups were comparable. After surgery, a decrease in resting lower esophageal sphincter pressure was observed in both groups, whereas the abdominal and overall lengths were significantly shorter among the asymptomatic @entity1 . No @entity1 with recurrence had @entity354 . Based on time to recurrence and manometric and fluoroscopic findings, the etiology of the recurrences was classified as @entity445 (n = 1), @entity445 or @entity1463 of the myotomy downward (n = 7), or sigmoid megaesophagus (n = 1); in one @entity1 the authors could not establish the etiology. Seven of nine @entity1 were effectively treated with endoscopic pneumatic dilations (median 2 dilations, range 1-4); one refused to undergo further treatment. Two @entity1 underwent redo surgery. CONCLUSIONS: Recurrence of symptoms after myotomy is mainly related to @entity445 or @entity1463 of the distal site of the myotomy; it can be treated by dilations after surgery.

Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for XXXX .

@entity1318 :: ('MESH:D004931', 'Disease') :: ['achalasia', 'esophageal achalasia'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity384 :: ('MESH:D002311', 'Disease') :: ['pneumatic dilation'] @entity445 :: ('MESH:C536298', 'Disease') :: ['incomplete myotomy', 'incomplete myotomy upward'] @entity1463 :: ('MESH:D012598', 'Disease') :: ['sclerosis'] @entity1282 :: ('MESH:D003680', 'Disease') :: ['dysphagia'] @entity354 :: ('MESH:D005764', 'Disease') :: ['abnormal gastroesophageal reflux']
@entity1318 :: (MESH:D004931,Disease) :: ['achalasia']
