Achalasia of the esophagus. Treatment controversies and the method of choice.
During a 15-year period, 62 patients were treated for achalasia of the esophagus. Pneumatic dilation (PD) had been performed initially in 46 and was successful in 23; failures were due to acute perforation of the esophagus, persistent dysphagia, or pathologic gastroesophageal reflux. Esophagomyotomy alone (EM) was performed in 19 individuals resulting in definite improvement in 12; four patients had moderate reflux or dysphagia, and three of these required another surgical procedure. An extended myotomy with an antireflux procedure (M-NF) was performed in 13 patients with symptomatic relief in 12; one patient required reconstruction of a too-tight fundoplication that caused persistent dysphagia. The advantages of pneumatic dilation were the ease of performance, patient acceptability, and an overall efficacy of 50%. Definitive surgical therapy, while more predictably effective in relieving dysphagia, was considerably more expensive in terms of patient discomfort and time. When pathologic reflux was present following a previous procedure, the M-NF was performed; obstruction of the esophagus did not occur if the fundoplication was "floppy." The M-NF deserves consideration as the surgical procedure of choice for achalasia.
P E
PE
Donahue
S
S
Samelson
P K
PK
Schlesinger
C T
CT
Bombeck
L M
LM
Nyhus
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003680:Deglutition Disorders / Q000150:complications; D004106:Dilatation / Q000379:methods; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000628:therapy*; D004939:Esophageal Perforation / Q000209:etiology; D004944:Esophagoplasty; D004947:Esophagus / Q000601:surgery; D005260:Female; D005748:Gastric Fundus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009132:Muscles / Q000601:surgery