Very long-term objective evaluation of heller myotomy plus posterior partial fundoplication in patients with achalasia of the cardia.
OBJECTIVE
To present the objectively assessed very long-term results of a prospective study of 149 patients with achalasia of the cardia who underwent Heller myotomy and posterior partial fundoplication.


BACKGROUND
Very few studies evaluate objectively the very long-term results to analyze whether the effectiveness of Heller myotomy is maintained with the passing of time.


METHODS
The study group consisted of 149 patients who underwent a Heller myotomy plus a posterior partial fundoplication through a laparotomy. The median follow-up was 6 years (range, 1-27 years). Follow-up period was over 10 years in 53 patients and over 15 in 36. Clinical, radiologic, endoscopic, manometric, and pHmetric evaluations were performed postoperatively.


RESULTS
Satisfactory results were higher than 90% up to 5 years. From that time on results gradually decreased to a 75% rate after 15 years (P < 0.001) due to either heartburn or dysphagia. Both the esophageal diameter and the mean resting pressure of the lower esophageal sphincter decreased postoperatively with no significant changes during follow-up. Esophagitis appeared in 11% of the patients (47% of them being asymptomatic) and 24-hour pH monitoring showed pathologic rates of acid reflux in 14% of patients, 58% of them being asymptomatic. Both esophagitis and pathologic rates of reflux appeared in >40% of the patients late in the follow-up.


CONCLUSIONS
Results after Heller myotomy plus posterior partial fundoplication deteriorate with time, although we achieved a 75% of satisfactory results after >15 years of follow-up. Our study highlights the importance of life long follow-up and the objective assessment of the results.
Ortiz
Angeles
A
Department of Surgery, University Hospital Virgen de la Arrixaca, CIBEREHD, Murcia, Spain.
de Haro
Luisa F Martinez
LF
Parrilla
Pascual
P
Lage
Ana
A
Perez
Domingo
D
Munitiz
Vicente
V
Ruiz
David
D
Molina
Joaquín
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000601:surgery*; D002648:Child; D016099:Endoscopy, Gastrointestinal; D004931:Esophageal Achalasia / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005744:Gastric Acid / Q000378:metabolism; D005745:Gastric Acidity Determination; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D011312:Pressure; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome