Three non-responsive patients required surgical laparoscopic myotomy
Present study is comparable in case of achalasia with Mattioli S  (1996) who had done long oesophagogastric myotomy
(abdominal) in 62% cases.
Material and Methods: This study was carried out on patients undergoing surgical repair of laparoscopic Heller myotomy
for cardiac achalasia at Combined Military Hospital Rawalpindi over a period of four years (2010 -2014).
She underwent Heller myotomy
6 months ago for achalasia.
Patients who previously had Heller myotomy
or refused pneumatic dilation were excluded from the study.
Predisposing factors may involve increased gastric mobility due to ligamental and omental laxity, increased intra-abdominal pressure, high negative intra-thoracic pressure during inspiration due to physical exertion and prior history of myotomy
and fundoplication (1-4).
Surgical treatment for achalasia of the esophagus: Laparoscopic heller myotomy
First-line therapy includes graded pneumatic dilation or laparoscopic myotomy
with a partial fimdoplication.
If intraoperative mouth opening is less than 35mm, then bilateral coronoidectomy or temporalis myotomy
was done through the same incision.
Hewitt, "Loop-end myotomy
ileostomy in the obese patient," Urologic Clinics of North America, vol.
Diverticulectomy and long segment myotomy
Finally, the pouch was excised using a 60-mm stapler, and a wide cricopharyngeal myotomy
Recurrence of symptoms occurs in 3-10 percent of patients at 6 months and is most commonly due to an incomplete myotomy
not extending below the gastroesophageal junction onto the stomach.
She had had eyelid repair operations at least 15 years previously, and had also had oesophageal sphincter botulinum toxin injections and myotomy
for severe dysphagia at the age of 56.
Keywords including achalasia, Heller's myotomy
and balloon dilatation were used and relevant articles included.