MANAGEMENT OF FAILED HELLERS OPERATIONS

An analysis of 29 patients who collectively required 33 reoperations f or failed Heller's esophagocardiomyotomy performed during the period b etween 1972 and 1992 was conducted. In the majority of patients, the r eoperation was necessitated because the original myotomy was not long or deep enough, or because of iatrogenic gastroesophageal reflux and i ts sequelae such as strictures, Identification of the exact cause of f ailure requires careful analysis of the patient's symptoms and of the findings of various diagnostic examinations, The treatment for inadequ ate myotomy generally involves performing a second myotomy, which is c ompleted by adding a nonobstructive antireflux repair, It appears that abolition of the ''sigmoid sac'' is essential even when the esophagog astric junction has a sufficiently large diameter. A so-called esophag oplication was performed in 3 patients, and an interposition at the si te of esophageal resection, using an isoperistaltic esophagojejunogast ric loop of appropriate length, was performed in 14 patients, There we re no deaths following reoperation, In fact, the results were excellen t or good in 23 cases and fair in 3.