Long-term results in surgically managed esophageal achalasia.
The long-term clinical results of surgical treatment for esophageal achalasia were reviewed in 35 patients having a minimum follow-up of 10 years. Group A (n = 22) are those patients whose first procedure (myotomy and Belsey partial fundoplication) was done at our hospital. Group B (n = 13) are those who had undergone one or more previous operations elsewhere. In group A good to excellent results occurred in 21/22 patients (95%) at 1 year, 17/22 (77%) at 5 years, 15/22 (68%) at 10 years, 11/16 (69%) at 15 years, and 6/9 (67%) at 20 or more years. Two patients underwent early reoperation (2 and 5 years) for dysphagia due to incomplete myotomy. Three patients underwent esophagectomy (7, 19, and 23 years) and one patient underwent an antrectomy and Roux-en-Y diversion (23 years) for late-onset complications of reflux. Three of 13 group B patients had had multiple prior operations and had severe reflux damage at presentation and underwent immediate esophagectomy. Ten patients had one or more conservative operations in our hospital, and 4 of these eventually required esophagectomy for disabling reflux. Therefore, there were 10 patients (groups A+B) who underwent esophageal resection, all but 1 of whom had endoscopically documented reflux and 5 of whom had peptic strictures. Six of the 10 esophagectomies were performed more than 10 years (13 to 23 years) after the first operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Malthaner
R A
RA
Division of Thoracic Surgery, Toronto Hospital, University of Toronto, Ontario, Canada.
Tood
T R
TR
Miller
L
L
Pearson
F G
FG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy; D004942:Esophagitis, Peptic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation