A combined surgical approach in the management of achalasia of the esophagus.

The treatment of achalasia at the present time is far from being ideal. The results of pneumatic dilatation have not always been impressive and the risk of esophageal perforation is real. Modified Heller operation has succeded in relieving obstructive symptoms in the majority of patients with achalasia. However, the reported incidence of reflux esophagitis following Heller myotomy is four to 37 per cent. In 25 patients with achalasia followed up to 10 years after Heller myotomy, nine patients had symptomatic reflux and three patients developed esophageal strictures. We believe the addition of an anti-reflux operation should be considered in all patients undergoing operation for achalasia and especially those patients with preoperative symptoms of reflux.