Controversies in Heller Myotomy

 In Achalasia Cardia surgical relief in the form of Heller's myotomy give the most long lasting relief from symptoms. There are a lot of controversies associated with  the procedure. We will be discussing these.

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Short Myotomy (1-1.5cm) on gastric wall Vs Long myotomy on gastric wall (3cm)

   Long myotomy has a significant less dysphagia but there is no difference in  postoperative chest pain, regurgitation or heartburn.

 

 

•Addition of Anti reflux procedure 

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•Partial fundoplication is recommended in most cases

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In the only randomized trial the addition of antireflux procedure decreased the incidence of reflux ninefold without having any impact on dysphagia

 

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Length of Myotomy--