Transthoracic oesophagomyotomy in the treatment of achalasia--a 15-year experience.
Oesophageal achalasia was treated with modified Heller's oesophagomyotomy in 51 patients (19 males, 32 females) via thoracotomy in 47 cases and thoracoscopy in 4 cases. A Belsey Mark IV antireflux procedure was added to transthoracic oesophagomyotomy in two cases, because of extended cardiomyotomy. There were no hospital deaths. The overall improvement rate was 93.5%, with excellent results in 80.6%. Postoperative follow-up averaged 7.4 years. In all four cases of thoracoscopic oesophagomyotomy, simultaneous oesophagoscopy was performed to facilitate the procedure. One patient required repeat surgery 2 months later because of inadequate myotomy. Thirty-one patients, including three with severe gastro-oesophageal reflux, received long-term medication. Barrett's oesophagus developed in two of the 31 patients (6.5%) 4.7 and 7.6 years, respectively, after myotomy and squamous cell carcinoma was diagnosed in a 44-year-old woman 2.2 years postoperatively. The study suggests that transthoracic oesophagomyotomy without antireflux procedure can provide excellent long-term relief of dysphagia in oesophageal achalasia and carries a low risk of serious postoperative complications.
Shai
S E
SE
Department of Surgery, Taichung Veterans' General Hospital, Taiwan, ROC. sse@vghtc.vghtc.gov.tw
Chen
C Y
CY
Hsu
C P
CP
Hsia
J Y
JY
Yang
S S
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013906:Thoracoscopy; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome