[Heller's myotomy without fundoplication: a series of 123 patients].
BACKGROUND
Surgical treatment of achalasia of lower oesophageal sphincter is Heller's myotomy, usually associated with a fundoplication due to an high risk of postoperative gastro-oesophageal reflux. The value of this fundoplication is discussed. The aim of this study was to evaluate retrospectively the results of Heller's myotomy without fundoplication but performed according to a precise technique preventing postoperative reflux.


METHODS
Between 1975 and 1999, 123 patients underwent Heller's myotomy without systematic fundoplication. Diagnosis of achalasia was performed clinically and confirmed by investigations: baryum meal, fibroscopy and manometry. Myotomy was performed through an abdominal approach in 117 (95%) patients. Dissection preserved fixity of abdominal oesophagus in all cases, particularly its posterior meso. Myotomy was performed on abdominal oesophagus but not below the cardia. Posterior fundoplication was associated in 2 patients.


RESULTS
One patient (0,8%) died from massive aspiration. Morbidity (1,6%) consisted in one peritonitis and one postoperative occlusion. At follow-up (mean = 5 years; range: 1-20), functional results were satisfying (excellent and good) in 112 (92%) patients. Seven patients (6%) developed postoperative reflux, including one who need surgical treatment. Dysphagia persisted in 3 patients (2%) who had to be reoperated.


CONCLUSIONS
Results of this series show that systematic fundoplication is not necessary in Heller's myotomy for achalasia of lower oesophageal sphincter.
Raiss
M
M
Clinique chirurgicale C, hôpital Ibn Sina, Rabat, Maroc. raissmed2@wanadoo.ma
Hrora
A
A
Menfaa
M
M
Al Baroudi
S
S
Ahallat
M
M
Hosni
K
K
Halhal
A
A
Tounsi
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome