05 Jan, 2014

Heller's myotomy: a hundred years of success!

Nelson Adami ANDREOLLO
Luiz Roberto LOPES
Osvaldo MALAFAIA
DOI: 10.1590/S0102-67202014000100001
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On April 14, 1913, Monday, the young surgeon of 36 years, Ernst Heller, assistant professor of Erwin Payr, Director of the Surgical Clinic of the University of Leipzig in Germany, while operating a patient with idiopathic achalasia of the esophagus, performed for the first time a cardiomyotomy extramucosal, leaving his enormous contribution to the history of esophageal surgery, in the 20th century1.

Ernst Heller was born in 1877 and as a young surgeon had in its formation the influence of various known surgeons of the time, such as Gottstein and Heyrovsky. Between 1914 and 1918 he served as a surgeon in the first World War, in the front. He returned to Leipzig in 1918 as chief surgeon of Saint George County Hospital. In 1949 he became Professor at the University of Leipzig and died at the age of 87 on November 2, 1964, and published over 80 scientific papers during their academic life2.

The record of his first extramucosal cardiomyotomy was published in the journal Mitt Grenzgeb Med Chir, describing in detail the clinical case, the surgical technique employed including figures, the evolution of the patient and reviews about the disease1,2 .

This is a briefing of original Heller´s report:

"In the first section of the Archiv für Chirurgie klinische 1913, described a Heyrovsky subdiafragmatic esofagogastric anastomosis that performed successfully in two cases of so-called "idiopathic dilatation of the esophagus". Shortly after the publication of this notice, came to the care of the surgical clinic of Leipzig, a patient with chronic saculiform cardiospasm and marked dilation of the esophagus, which seemed appropriate the surgical treatment for elimination of suffering. Under the impression of Heyroyvsky successes, I intend to perform the surgery in the same way. During the surgery, however, due to certain difficulties and after theoretical considerations, I ended up running a different intervention from the original plan, performing a cardioplasty extramucosal. In advance as I want to note that the functional point of view was very exceptionally satisfactory, and this change in the surgical procedure has, in my view, important practical advantage compared to the operational measures proposed and followed in the treatment of cardiospasm by esophageal dilatation, I wish allowing me to share briefly the case ....


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