Usefulness of intraoperative manometry in surgical treatment of esophageal achalasia

Abstract The principal causes of failure of the surgical treatment of achalasia are gastroesophageal reflux and obstructive dysphagia due either to an incomplete myotomy or to a narrow antireflux procedure. In 1978 Hill introduced intraoperative manometry to check the completness of the myotomy and to calibrate the antireflux procedure to avoid postoperative gastroesophageal reflux and/or dysphagia. The authors used intraoperative manometry in sixteen cases of achalasia operated on with a Heller plus Nissen procedure. After myotomy a pressure of zero cm H2O was reached. The intraoperative degree of stricture obtained with the Nissen procedure corresponded to a pressure of 20 cm H2O. The clinical results were good in 15 cases and fair in one case. Comparing these results with those obtained in 38 patients previously operated on with a Heller plus Nissen fundoplication without using intraoperative manometry (good in 32, fair in 4 and poor in 2 cases) the authors conclude that this procedure may improve the results of surgical therapy of esophageal achalasia.