Achalasia. Results of myotomy and antireflux operation after failed dilatations

E. Cosentini, G. Berlakovich, J. Zacherl, G. Stacher-Janotta, R. Merio, E. Wenzl, H. Bergmann and G. Stacher
Division of General Surgery, University of Vienna, Austria.

OBJECTIVE: To evaluate the outcomes of patients with achalasia who had undergone myotomy and an antireflux operation because dilatations had not yielded satisfactory results. DESIGN: Retrospective analysis. SETTING: University-based tertiary care center. PATIENTS: Of 39 patients who met inclusion criteria, 18 female patients and 18 male patients (age range; 17-85 years; median age, 54 years; range of time elapsed since operation, 1-22 years; median time, 6 years) could be studied. Antireflux operations included 360 degrees fundoplications in 27 patients, anterior hemifundoplications in 5 and other procedures in 4. MAIN OUTCOME MEASURES: Dysphagia for solid foods and liquids, regurgitation, heartburn, retrosternal pain and body weight. RESULTS: Excellent, good, and fair results of myotomy and antireflux operation were encountered in 14, 3, and 6 patients, respectively, and poor or absent results in the remaining 13 patients. The resting pressure of the lower esophageal sphincter was significantly lower at follow-up than preoperatively, and this was associated with reduced dysphagia for solid foods in 14 patients and for liquids in 16 of 17 patients. CONCLUSIONS: Myotomy and antireflux operation yielded excellent to fair results in 23 patients in whom dilatations had not facilitated swallowing. Poor results in the remaining 13 patients seemed to be attributable to the 360 degrees fundoplication performed in 12 of them. In these patients, a further surgical intervention seemed to be indicated.