ESOPHAGEAL RESECTION FOR RECURRENT ACHALASIA

Background. This study examined esophageal resection as treatment for recurrence or treatment complications of achalasia. Methods. From 1976 through 1992, 37 patients (20 men and 17 women) underwent esophageal resection after initial surgical treatment for achalasia. The median a ge was 56 years (range, 19 to 84 years). Initial surgical treatment co nsisted of modified Heller myotomy in 28 patients, combined myotomy an d antireflux procedure in 6, and antireflux procedure alone in 3. Twen ty-six patients required an additional surgical procedure before esoph ageal resection (70.3%). Indication for esophageal resection was obstr uctive symptoms in 30 patients, cancer in 3, bleeding in 2, and perfor ation during dilation in 2. Reconstruction was established with the st omach in 26 patients, colon in 6, and small bowel in 5. Anastomosis wa s at the cervical level in 20 patients (54.1%) and intrathoracic in 17 (45.9%). Results. There were two operative deaths (5.4%), both caused by intraoperative hemorrhage during transhiatal resection. Twelve pat ients (32.4%) had complications, which included cardiac dysrhythmia in 3, cervical anastomotic leak in 2, transient vocal cord paralysis in 2, pneumonia in 2, pulmonary embolus in 2, and reexploration for bleed ing in 1. Follow-up was complete in all patients and ranged from 1.4 t o 16 years (median, 6.3 years). Excellent or good long-term functional results were present in 32 patients (91.4%). Conclusions. Esophageal resection provides reasonable long-term functional results in patients with recurrence or treatment complications of achalasia. In our exper ience, transhiatal resection is associated with increased morbidity an d mortality.