The mean duration of the procedure was 105 minutes (range 85�C135 min). The NGT inserted before surgery was removed on postoperative day (POD) 1, and patients underwent barium swallow to assess esophageal transit and/or integrity. They recommenced feeding and were discharged on POD 3. There were no major intra- or postoperative complications requiring Imatinib mechanism transfer to intensive care in any patient (23). As already noted, iatrogenic perforation of the distal esophagus occurred in just two cases (8%), both of which were in the early days of our use of the technique. These were treated intraoperatively with direct suturing (3, 24, 25). In these two cases the NGT was only removed on POD 3 and barium swallow to assess transit was performed on POD 4. There was no morbidity or mortality.

This is probably due in part to the youth and good health of the patients undergoing surgery in comparison with those referred to other treatments (26). Discussion There is as yet no consensus about the follow-up of patients treated for achalasia, but it is good practice to follow up the patients every 6�C12 months, even if no clinical symptoms are reported. Our clinical experience in these years has led us to apply a strict follow-up program, at least in the first year. About a month after surgery, the patient undergoes another clinical and radiological examination with esophageal videofluorography to assess the anatomy of the residual gastroesophageal junction and the results of the myotomy. Manometry and pH testing are repeated at 6 months to assess any reflux and revise the therapy accordingly.

In asymptomatic patients with a good response to the treatment, esophagogastroduodenoscopy (EGDS) is performed at 1 year. Patients are subsequently followed up annually, but this can of course be revised if the Dacomitinib patient experiences any symptoms (27, 28). The recent identification of various preoperative manometric patterns in different patients also provides information on their probable subsequent clinical outcome (29�C31). The patients discussed herein have so far been followed up for just 3 years, but the results so far are satisfactory. There have been no recurrences to date. One patient experienced transient postoperative dysphagia, which resolved with medical treatment in two weeks. Follow-up videofluorography showed complete esophageal emptying once the LES obstruction had been removed. Manometry revealed that the fundoplication was of normal length, position and caliber and that the LES pressure was insignificant or significantly reduced with respect to preoperative values in the same patient. Intraoperative manometry was performed in all patients (Fig. 2). Intraoperative EGDS was only necessary in one case.