Esophagocardiomyotomy for achalasia. Long-term clinical and endoscopic evaluation of transabdominal vs. transthoracic approach.

Modified Heller's myotomy for achalasia of the esophagus was performed via a left thoracotomy in 34 cases (group A) and via an upper midline abdominal incision in 30 (group B). There were no perioperative deaths. Complications arose in ten cases. After follow-up averaging 13 years (range 3-24 years) 4% of the group A patients reported dysphagia for solids, but none for liquids, and in group B the corresponding figures were 52% and 26%. Reflux symptoms were present in 30% of the group A and 60% of the group B cases, and the respective incidence of microscopic esophagitis was 30% and 43%. There were three esophageal strictures, all in group B, and three cases of Barrett's epithelium, all in group A. Because of the high incidence of esophagitis and its complications following esophagomyotomy for achalasia, yearly endoscopy with biopsy and brush cytology is recommended. When myotomy is performed, an antireflux operation should be added.