title: Esophagomyotomy versus forceful dilation for achalasia of the esophagus: results in 899 patients.
abstract: Between 1949 and 1976, 899 patients underwent treatment for achalasia of the esophagus at the Mayo Clinic, 431 by forceful hydrostatic or pneumatic dilation and 468 by a standardized transthoracic esophagomyotomy. Esophageal leak and mediastinal sepsis was an uncommon but major complication of both types of therapy, occurring four times more often with dilation (4%) than with myotomy (1%), although no deaths resulted from this in either group. The 30-day mortality was 0.2% after myotomy and 0.5% after forceful dilation. Although there was minimal morbidity and mortality with either modality, the late results were significantly superior after myotomy. Excellent to good results were obtained by 85% of the group treated with myotomy but only by 65% of those treated with hydrostatic dilation. Late poor results were encountered three times more frequently after dilation (19%) than after myotomy (6%). Analysis of poor results after myotomy indicates that late serious complications of gastroesophageal reflux developed in only 3% of patients operated on.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D004931:Esophageal Achalasia / Q000601:surgery / Q000628:therapy*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery; D006801:Humans; D006874:Hydrostatic Pressure; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010166:Palliative Care; D011183:Postoperative Complications; D012306:Risk