title: Surgical treatment of achalasia: transabdominal versus transthoracic cardiomyotomy.
abstract: BACKGROUND
  Achalasia is a primary esophageal motor disorder involving the body of the esophagus and lower esophageal sphincter. The mechanism is destruction of the myenteric plexus after a viral infection. Multiple methods of treatment with variable results induced in achalasia.
  
  
  METHODS
  We analyzed 70 patients with achalasia that underwent surgical treatment with transabdominal or transthoracic cardiomyotomy from 1982 to 2008 in Mashhad (Ghaem and Omid) hospital and at least 2 years follow up for evaluated result of surgery.
  
  
  RESULTS
  The mean age was 39.2 ± 9.42 years and the M/F = 0.89. The most common symptom was dysphagia (100%). The interval between beginnings of symptoms to a definitive diagnosis was 10.6 ± 8.3 month. The ratio between the two techniques was 35/35 = 1. In 67.1% of patients, a previous history of pneumatic dilation was reported. Long-term good results after surgery were seen in 77.2% of patients. Recurrence after surgical treatment was seen in 22.8%. A comparison of the two techniques (with or without antireflux surgery), showed a greater failure rate in transabdominal cardiomyotomy without the antireflux protocol (8/15 = 40%), but by the chi- square test, the difference was not statistically significant (P = 0.107). The most common complication after surgery was esophageal leakage (2.85%), and mortality was zero. In recurrence, most patients underwent pneumatic dilation (9/16 = 56.2%), and if surgery was needed, all patients underwent a transthoracic approach with antireflux treatment.
  
  
  CONCLUSIONS
  Based on the good, long-term results with the surgical treatment of achalasia, surgery is recommended in most patients. A transthoracic or transabdominal approach had good, long-term results, but a transthoracic approach had better results and usually did not need antireflux surgery.
authors.affiliation: Thoracic Surgery, Mashhad University of Medical Sciences, Ahmad Abad Street, Mashhad, Iran. Bagherir@mums.ac.ir
authors.forename: Reza
authors.initials: R
authors.lastname: Bagheri
authors.forename: S Ziaallah
authors.initials: SZ
authors.lastname: Haghi
authors.forename: Sadjad
authors.initials: S
authors.lastname: Noorshafiee
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002299:Cardia / Q000601:surgery*; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004931:Esophageal Achalasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult