INTRAOPERATIVE ESOPHAGEAL MANOMETRY IN SURGICAL-TREATMENT OF ACHALASIA - A REAPPRAISAL

Background/Aims: Intraoperative Esophageal Manometry is used during su rgery for gastroesophageal reflux disease to obtain a better lower eso phageal sphincter pressure, or during the Heller procedure for achalas ia to verify the myotomy. The effectiveness of this manometry is not e xplicit. Material and Methods: From 1977 to 1987, 58 patients underwen t surgery for achalasia at our Institution. A transabdominal Heller's myotomy and a modified Dor's anterior fundoplication were performed in all cases. During the operation, Lower Esophageal Sphincter Pressure was measured in 38 patients (A group) to verify the completeness of th e cardiomyotomy; the fundoplication- induced pressure increase was als o recorded. Twenty patients (B group) underwent surgery without intrao perative manometry. Forty-six patients (30 of A group and 16 of B grou p) were followed up for 24 to 120 months (median 68 months) by means o f a clinical questionnaire, barium meal, manometry and 24-hour esophag eal pH monitoring. Results: In 21 cases, intraoperative manometry show ed the completeness of the myotomy at the first record, while in the r emaining 17 it revealed the persistence of a High Pressure Zone; in th ese, a more accurate incision of the muscle layers on the anterior sur face of the esophagus was subsequently performed up to a complete abol ition of the HPZ. Long-term results were excellent or good in 27 (90%) patients of A group and in 9 (56%) patients of B group. Dysphagia and gastro-esophageal reflux were the commonest findings in patients with poor results. Conclusion: The usefulness of intraoperative manometry in the surgical treatment of achalasia is emphasized and same technica l details are reported.