Reoperations for esophageal achalasia.
OBJECTIVE
To define the factors predisposing to recurrence and evaluate the results of reoperations for achalasia.


METHODS
We reviewed the medical records of ten patients (4 men and 6 women; mean age, 51.5 ± 11.0 years), who underwent reoperations for achalasia between August 1994 and August 2010.


RESULTS
The primary surgical procedures were Heller-Dor (HD) cardioplasty in nine patients and Heller myotomy in one patient. The factors contributing to failure of the primary operation included inadequate myotomy (n = 2), recurrent adhesion after myotomy (n = 2), reflux esophagitis (n = 2), difficulty in passage caused by tortuosity of the esophagus (n = 2), difficulty in passage through the thoracic esophagus (n = 1), and severe chest pain (n = 1). The reoperations included repeated HD procedures (n = 4), repair of an esophageal hiatal hernia (n = 2), thoracic esophageal myotomy (n = 2), straightening of the lower esophagus with gastropexy (n = 1), and subtotal esophagectomy (n = 1). The success rate of the reoperations for resolving symptoms was 90 % (9 patients).


CONCLUSIONS
Selecting surgical procedures based on the causes and conditions of recurrence led to symptomatic improvement and acceptable outcomes.
Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan. surgomura@jikei.ac.jp
Nobuo
N
Omura
Hideyuki
H
Kashiwagi
Fumiaki
F
Yano
Kazuto
K
Tsuboi
Katsuhiko
K
Yanaga
D000328:Adult; D015331:Cohort Studies; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome