Heller myotomy versus heller myotomy with Dor fundoplication for achalasia.

The article by Richards et al1 is a very interesting and well-conducted randomized, double-blind study concerning the results of laparoscopic treatment of esophageal achalasia. While comparing Heller myotomy plus Dor fundoplication versus Heller myotomy alone, the authors concluded that the former technique is superior in regard to control the incidence of episodes of postoperative gastroesophageal reflux evaluated with 24-hour pH monitoring study. Richards et al analyze one of the major problem concerning the surgical treatment of esophageal achalasia, that is, the impact of gastroesophageal reflux that follows Heller myotomy, while the authors are not concerned about recurrent achalasia, which, in our opinion, is the real problem after treatment.