Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication

L. Bonavina, A. Nosadini, R. Bardini, M. Baessato and A. Peracchia
First Department of Surgery, University of Padua, Medical School, Italy.

From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Improving the surgery for sigmoid achalasia: long-term results of a technical detail
Faccani et al.
Eur. J. Cardiothorac. Surg. 2007;32:827-833.
ABSTRACT | FULL TEXT  

Long-term results after Heller-Dor operation for oesophageal achalasia.
Ruffato et al.
Eur. J. Cardiothorac. Surg. 2006;29:914-919.
ABSTRACT | FULL TEXT  

Laparoscopic Esophageal Myotomy for Achalasia: Factors Affecting Functional Results
Deb et al.
Ann. Thorac. Surg. 2005;80:1191-1195.
ABSTRACT | FULL TEXT  

Comparative pre- and postoperative results analysis of functional state of the esophagus assessment in patients with various stages of achalasia
Onopriev et al.
Eur. J. Cardiothorac. Surg. 2005;28:1-6.
ABSTRACT | FULL TEXT  

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience
Mineo and Ambrogi
Eur. J. Cardiothorac. Surg. 2004;25:1089-1096.
ABSTRACT | FULL TEXT  

Radionuclide Gastroesophageal Motor Studies
Mariani et al.
JNM 2004;45:1004-1028.
ABSTRACT | FULL TEXT  

Improved Outcome After Extended Gastric Myotomy for Achalasia
Oelschlager et al.
Arch Surg 2003;138:490-497.
ABSTRACT | FULL TEXT  

Outcomes after minimally invasive esophagomyotomy
Luketich et al.
Ann. Thorac. Surg. 2001;72:1909-1913.
ABSTRACT | FULL TEXT  

Laparoscopic Heller Myotomy Improves Esophageal Emptying and the Symptoms of Achalasia
Finley et al.
Arch Surg 2001;136:892-896.
ABSTRACT | FULL TEXT  

VIDEO-ASSISTED SURGICAL MANAGEMENT OF ACHALASIA OF THE ESOPHAGUS
Wiechmann et al.
J. Thorac. Cardiovasc. Surg. 1999;118:916-923.
ABSTRACT | FULL TEXT  

Laparoscopic Esophageal Myotomy and Anterior Partial Fundoplication for the Treatment of Achalasia
Graham et al.
Ann. Thorac. Surg. 1997;64:785-789.
ABSTRACT | FULL TEXT  

Results of Myotomy and Partial Fundoplication After Pneumatic Dilation for Achalasia
Ferguson et al.
Ann. Thorac. Surg. 1996;62:327-330.
ABSTRACT | FULL TEXT  

Onset Timing of Delayed Complications and Criteria of Follow-up After Operation for Esophageal Achalasia
Di Simone et al.
Ann. Thorac. Surg. 1996;61:1106-1110.
ABSTRACT | FULL TEXT