Transthoracic oesophagomyotomy in the treatment of achalasia - A 15-year experience

Oesophageal achalasia was treated with modified Heller's oesophagomyotomy i n 51 patients (19 males, 32 females) via thoracotomy in 47 cases and thorac oscopy in 4 cases. A Belsey Mark IV antireflux procedure was added to trans thoracic oesophagomyotomy in two cases, because of extended cardiomyotomy. There were no hospital deaths. The overall improvement rate was 93.5%, with excellent results in 80.6%. Postoperative follow-up averaged 7.4 years. In all four cases of thoracoscopic oesophagomyotomy, simultaneous oesophagosc opy was performed to facilitate the procedure. One patient required repeat surgery 2 months later because of inadequate myotomy. Thirty-one patients, including three with severe gastrooesophageal reflux, received long-term me dication. Barrett's oesophagus developed in two of the 31 patients (6.5%) 4 .7 and 7.6 years, respectively, after myotomy and squamous cell carcinoma w as diagnosed in a 44-year-old woman 2.2 years postoperatively. The study su ggests that transthoracic oesophagomyotomy without antireflux procedure can provide excellent long-term relief of dysphagia in oesophageal achalasia a nd carries a low risk of serious postoperative complications.