Long-term effects of myotomy and partial fundoplication for esophageal achalasia

• Published in: Diseases of the esophagus 2002-01, Vol.15 (2), p.171-179
• Main Authors: Chen, L.-Q., Chughtai, T., Sideris, L., Nastos, D., Taillefer, R., Ferraro, P., Duranceau, A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Esophageal Achalasia - diagnostic imaging; Esophageal Achalasia - physiopathology; Esophageal Achalasia - surgery; Esophagoscopy; Esophagus - surgery; Female; Fundoplication - methods; Humans; Male; Manometry; Middle Aged; Radionuclide Imaging; Treatment Outcome
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1046/j.1442-2050.2002.00248.x

Controversy persists in the surgical approach to treat esophageal achalasia. This investigation reports the long‐term effects of esophageal myotomy and partial fundoplication in treating this disorder. From 1984 to 1998, 32 patients with achalasia underwent myotomy and partial fundoplication (Belsey Mark IV) using a left thoracotomy. The median follow up is 7.2 years. Assessments include clinical evaluation, esophagogram, radionuclide transit, manometry, 24‐h pH, and endoscopy. There is no complication and no mortality. Preoperative assessment was compared with that in 0–3, 3–7, and 7–16 postoperative years. Clinically, the prevalence of dysphagia was decreased from 100% to 6%, 12%, and 13%, respectively (P  0.25). On radiology, the prevalence of barium stasis was decreased from 97% to 44%, 48%, and 47%, respectively (P=0.001), whereas a pseudo‐diverticulum was observed in two‐thirds of patients after operation (P=0.001). Percent radionuclide stasis at 2 min was measured as 70%, 17%, 20%, and 20%, respectively (P=0.001). Manometrically, lower esophageal sphincter (LES) gradient was decreased from 29 to 10, 9, and 9 mmHg, respectively (P=0.001). LES relaxation was improved from 41% preoperatively to 100% postoperatively at each postoperative period (P  0.25). In conclusion, on long‐term follow up, myotomy and partial fundoplication for achalasia relieve obstructive symptoms and improve esophageal emptying, and reduce LES gradient and improve LES relaxation. Acid reflux is recorded in 13% of patients and esophageal mucosal damage is identified in 11% of the patient population. A longer myotomy not covered by the fundoplication results in pseudodiverticulum formation and increased esophageal retention.