Short myotomy for vigorous achalasia.

Vigorous achalasia hers been considered an indication for surgery, in which a thoracic approach is recommended for extending the myotomy along the It hole of the oesophageal body to the point where manometry shows high-amplitude waves. Clinical results and postoperative manometric findings in 16 patients I-vith vigorous achalasia undergoing abdominal surgery with myotomy limited to the lower oesophageal sphincter (LOS),cei e analysed to assess whether extended myotomy is necessary in surgery for this form of achalasia. The clinical results were excellent or goon in all cases. Surgery induced a significant decrease (P<0.01) in the diameter of the oesophagus as determined radiologically. The most significant postoperative manometric changes were a decrease in the resting pressure of the LOS and oesophageal body, a lowering of wave amplitude at all levels of the oesophagus, and a reduction in the proportion of repetitive waves. The results suggest that vigorous achalasia can be tl eaten surgically in the same way as classical achalasia and question, at least from a therapeutic viewpoint, the use of the term vigorous achalasia.