SURGICAL-TREATMENT OF ACHALASIA - A RETROSPECTIVE COMPARATIVE-STUDY

A retrospective study carried out on 74 patients among 101 consecutive cases of achalasia of the esophagus operated from 1967 to 1989 is rep orted. On 21 patients observed between 1967 and 1975, a standard trans abdominal Heller cardiomyotomy was performed (group A). From 1976 to 1 989, the treatment of choice was a Heller myotomy associated with a mo dified Dor's fundoplication. In 80 consecutive cases (group B) the ext ension of myotomy was regulated by intraoperative monitoring of lower esophageal sphincter pressure. A 5-year follow-up with questionnaires, physical examination, and barium swallows was carried out on 16 patie nts in group A and on 58 patients in group B. In 75.6% of the cases (5 6 patients) follow-up examinations included esophageal manometry and 2 4-hour esophageal pH monitoring. Recurrence of dysphagia was recognize d in 3 cases in group A (18.7%) and in 2 cases in group B (3.4%) (P = 0.053); postoperative gastroesophageal reflux, measured as a percentag e of total reflux time, showed a significantly lower mean value in gro up B than in group A (1.8% vs. 4.1%. P < 0.01). This study suggests th at an anti-reflux procedure lowers postoperative gastroesophageal refl ux after Heller myotomy. Due to the low incidence of postoperative ref lux and the negligible recurrence of dysphagia, Heller myotomy associa ted with a modified Dor's fundoplication may represent the surgical tr eatment of choice for achalasia of the esophagus.