Primary Treatment of Esophageal Achalasia

摘要: • From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according the Dor technique. In majority patients, cardia was not mobilized, extended in length about 10 cm (8 on esophagus 2 stomach). There no operative mortality. Two (0.9%) required reoperation due bleeding from site one leakage gastrotomy other. One hundred ninety-three entered follow-up study were followed up 12 144 months (median, 64.5 months). Five died during unrelated diseases, patient, an cancer infiltrating trachea discovered 26 after operation. Clinical results excellent or good 93.8% fair 2.6%. Disabling dysphagia recurred seven (3.6%), six whom pneumatic dilation relief patient who because a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed significant reduction mean value maximal diameter. Esophageal manometry lower sphincter pressure over preoperative values. Twenty-four—hour pH monitoring abnormal acid exposure (8.6%) 81 tested. Of these had erosive esophagitis endoscopy. transit scintigraphy, performed 11 improvement time erect position compared with We concluded that esophagomyotomy combined is safe, effective, durable procedure achalasia. ( Arch Surg . 1992;127:222-227)