ESOPHAGOCARDIOMYOTOMY - FLOPPY NISSEN FUNDOPLICATION EFFECTIVELY TREATS ACHALASIA WITHOUT CAUSING ESOPHAGEAL OBSTRUCTION

Background. Effective surgical treatments for achalasia of the esophag us facilitate swallowing by division of muscles that Jail to relax nor mally during swallowing. If esophagocardiomyotomy is performed a compl ementary antireflux procedure is mandatory to prevent postoperative ga stroesophageal reflux We evaluated patients who had undergone a circum ferential antireflux procedure after esophagocardiomyotomy to determin e the effects of this procedure in patients with an aperistaltic esoph agus. Methods. During the past 15 years we treated 94 patients with ac halasia by use of pneumatic dilation (66), esophageal myotomy (19), or esophagocardiomyotomy with floppy Nissen fundoplication (24). Achalas ia was defined by radiographic and manometric criteria until 1986 when computerized axial manometry of the esophagus was initiated, providin g information about ''volume'' of the lower esophageal sphincter in ad dition to the usual manometric data. Results. Dysphagia was effectivel y relieved in all, and neither postoperative reflux nor esophageal obs truction was observed after esophagocardiomyotomy followed by floppy N issen fundoplication. The measured lower esophageal sphincter pressure s and sphincter volume were markedly reduced. Conclusions. Esophagocar diomyotomy with floppy Nissen fundoplication is an effective treatment for achalasia; clinical evidence of obstruction of the esophagus was not seen, and manometric data were typical of a weakened sphincter.