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July 1980


Arch Surg. 1980;115(7):890. doi:10.1001/archsurg.1980.01380070076021

To the Editor.—I have read with interest the article by Jara et al entitled "Long-term Results of Esophagomyotomy for Achalasia of the Esophagus" (Archives 114:935-936, 1979). The authors concluded that because they found a high incidence of reflux (53%), they felt compelled to recommend that an antireflux procedure be added to the myotomy. This experience is so at variance with mine and that of other surgeons, that I cannot let this recommendation go unchallenged. I have been doing a modification of the Heller operation for 25 years, and postoperative reflux has not been a problem.1 I do not agree that "this operation disrupts the lower esophageal sphincter with the creation of an incompetent valve that exposes the esophagus to the deleterious effects of the acid content of the stomach on the esophageal mucosa." The pinchcock mechanism at the esophagogastric junction is more related to the musculature of the

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