Long-term effect of total fundoplication on the myotomized esophagus.

摘要: From 1978 to 1983, 17 patients had an esophagocardiomyotomy with added short total fundoplication as antireflux procedure. Thirteen achalasia and 4, diffuse esophageal spasm. All initially the usual symptoms of these motor disorders. Early after operation all became asymptomatic, but over years follow-up, reappeared in 14 patients, 5 required reoperation. The distal transverse diameter showed progressive dilatation from 3.9 cm preoperatively more than 6 10 evolution. Over same period, deterioration emptying capacity caused stasis increase 32% 75%. Manometric changes were significant operation: resting pressures body decreased 10.5 4.4 mm Hg (p < 0.001) proximally 12.2 4.6 distally 0.001). Peak contraction significantly weaker: 38 30 proximal esophagus 49.2 28.1 Tertiary contractions unchanged distally, peristalsis 30% swallows half body. pressure gradient lower sphincter area was reduced 25.5 7.4 by operation. This remained stable follow-up. No acid exposure documented 8 undergoing 24-hour pH recordings their Endoscopy revealed retention without evidence reflux esophagitis damage. Total when associated myotomy results improved early postoperative phase.(ABSTRACT TRUNCATED AT 250 WORDS)