FACTORS INVOLVED IN THE RETURN OF PERISTALSIS IN PATIENTS WITH ACHALASIA OF THE CARDIA AFTER HELLERS MYOTOMY

Objective: To assess the reappearance of peristalsis in a group of 45 patients with achalasia of the cardia undergoing surgery and to analyz e the factors involved in this phenomenon. Methods: According to the p ostoperative manometric data, the 45 patients were divided into two gr oups, depending on whether or not they presented a return of peristals is. A statistical comparison of age, sex, duration of the disease, pre - and postoperative radiological diameter of the esophagus, classic or vigorous nature of the achalasia, and manometric data of the lower es ophageal sphincter and esophageal body was made. Results: In 46.6% of the patients, peristalsis returned to the upper esophagus, and 100% of the waves were progressive; in 24.4%, peristalsis returned to the mid dle third also, but only 50% of the waves were progressive; and in 8.8 % (four patients), peristaltic activity returned to the whole esophagu s, but only 40% of the waves were progressive. The group of patients w ith a return of peristalsis had a shorter duration of dysphagia, less preoperative dilation of the esophagus, and a greater contractile acti vity of the esophageal body. Conclusions: Return of peristalsis is a f requent phenomenon after myotomy in patients with achalasia of the car dia, especially in cases of short clinical evolution, little esophagea l dilation, and a conserved contractile capacity, although its accurat e production mechanism is unknown.