Transthoracic Heller Myotomy for Esophageal Achalasia

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Surgical treatment of achalasia is still now controversial. In the last thirty years two main antithetic surgical trends developed. These differ in several technical points, particularly regarding the myotomy extends upward to the level of left inferior pulmonary vein. An adequate length of the abdominal esophagus is an important factor in maintaining gastroesophageal competence. We do not believe better functional results could be obtained by a shorter myotomy on the thoracic esophagus. On the contrary, a shorter myotomy is potentially inadequate in those intermediate motor disorders between achalasia and diffuse spasm, which are not always discriminated even by preoperative manometry. addition or not of an antireflux procedure after the myotomy.