Longterm results of esophageal myotomy for achalasia

BACKGROUND: Achalasia is a progressive, noncurable, motor disorder of the e sophagus. Myotomy of the distal esophagus is the principal method of provid ing palliation. A major controversy is the necessity for a complementary an tireflux procedure. STUDY DESIGN: Forty-two patients were studied by clinical history manometri cally, roentgenographically, and endoscopically. Transabdominal Heller myot omy is the preferred approach. Nine patients had Nissen fundoplication and parietal cell vagotomy (group 1), and 16 had posterior gastropexy and parie tal cell vagotomy (group II). Initially 16 of 17 patients underwent transth oracic Heller myotomy without fundoplication (group III). Twenty-five patie nts were followed a mean of 10 years (range 5 to 26 years). RESULTS: One postoperative death was from adult respiratory distress. Resul ts in group I were excellent in five, good in three, and fair in one. The p atient with a fair result developed a diverticulum at the myotomy site and significant reflux at 9 years. Results in group II patients were excellent in 2, good in 11, there was 1 operative death, and no followup in 1. Of the 17 patients in group III, 3 had resection of an esophageal diverticulum, a nd 3 had closure of esophageal perforation caused by pneumatic dilatation. Results in the 13 patients followed were excellent in 6, good in 5, and poo r in 2. CONCLUSIONS: There is no statistical difference in results by chi-square an alysis between transthoracic Heller myotomy without fundoplication and tran sabdominal Heller myotomy with parietal cell vagotomy and Nissen fundoplica tion or posterior gastropexy (J Am Coll Surg 2001;193: 137-145. (C) 2001 by the American College of Surgeons).