ACHALASIA - RESULTS OF MYOTOMY AND ANTIREFLUX OPERATION AFTER FAILED DILATATIONS

Objective: To evaluate the outcomes of patients with achalasia who had undergone myotomy and an antireflux operation because dilatations had not yielded satisfactory results. Design: Retrospective analysis. Set ting: University-based tertiary care center. Patients: Of 39 patients who met inclusion criteria, 18 female patients and 18 male patients (a ge range, 17-85 years; median age, 54 years; range of time elapsed sin ce operation, 1-22 years; median time, 6 years) could be studied. Anti reflux operations included 360 degrees fundoplications in 27 patients, anterior hemifundoplications in 5, and other procedures in 4. Main Ou tcome Measures: Dysphagia for solid foods and liquids, regurgitation, heartburn, retrosternal pain, and body weight. Results: Excellent, goo d, and fair results of myotomy and antireflux operation were encounter ed in 14, 3, and 6 patients, respectively, and poor or absent results in the remaining 13 patients. The resting pressure of the lower esopha geal sphincter was significantly lower at follow-up than preoperativel y, and this was associated with reduced dysphagia for solid foods in 1 4 patients and for liquids in 16 of 17 patients. Conclusions: Myotomy and antireflux operation yielded excellent to fair results in 23 patie nts in whom dilatations had not facilitated swallowing. Poor results i n the remaining 13 patients seemed to be attributable to the 360 degre es fundoplication performed in 12 of them. In these patients, a furthe r surgical intervention seemed to be indicated.