ESOPHAGOMYOTOMY FOR ACHALASIA - A 22-YEAR EXPERIENCE

To determine the clinical results in achalasia, particularly as regard s postoperative gastro-oesophageal reflux, a 22-year personal experien ce with transthoracic short oesophagomyotomy without an antireflux pro cedure was analysed. A total of 185 such procedures were performed, of which 179 (97 per cent) were available for analysis. There was an ove rall improvement rate of 89 per cent over a mean postoperative interva l of 9 years. Primary procedures were followed by a 93 per cent rate o f improvement. Twenty patients, nine of whom had previously undergone one or more oesophageal operations, were considered as having a poor r esult. Marked gastro-oesophageal reflux accounted for a poor outcome i n nine patients. Although the overall rate of postoperative improvemen t did not deteriorate significantly with time, the level of improvemen t did, the proportion of excellent results declining from 54 to 32 per cent (P = 0.02) at 10-20 years after operation. These findings substa ntiate the view that a short transthoracic oesophagomyotomy without an antireflux procedure provides excellent long-term relief of dysphagia for the patient with oesophageal achalasia and is accompanied by an e xtremely low risk of serious postoperative gastro-oesophageal reflux.