Surgical repair of esophageal perforation due to pneumatic dilatation for achalasia. Is myotomy really necessary?
V. E. Pricolo, C. S. Park and W. R. Thompson
Department of Surgery, Rhode Island Hospital, Providence 02903.
Esophageal perforation is a rare complication of pneumatic dilatation for
achalasia. The few clinical series reported in the literature recommend,
under most circumstances, esophageal repair combined with
esophagocardiomyotomy. However, the superiority of this technique over
repair alone has never been proven. We reviewed our experience, since 1979,
with six operative cases of esophageal perforation from pneumatic
dilatation for achalasia. After debridement, the esophagus was repaired
and, if possible, buttressed with a gastric fundal patch. There was only
one late postoperative death due to sepsis and one upper gastrointestinal
bleeding complication in our series. Follow-up (1 to 12 years) revealed no
dysphagia in any of the five surviving patients and mild gastroesophageal
reflux in two. From a review of the literature we found no reports of
similarly treated patients experiencing recurrent symptoms of achalasia. In
these acutely ill patients, our operative strategy is more feasible than
repair and esophagocardiomyotomy and equally effective.
