Late subjective and objective evaluation of the results of esophagomyotomy in 100 patients with achalasia of the esophagus.

One hundred patients with achalasia of the esophagus were analyzed at a late follow-up by means of subjective and objective parameters. The surgical technique consisted of an anterior esophagomyotomy (6 cm long, not extending into the stomach more than 5 to 10 mm) with the addition of an anterior hemi-Nissen or Dor procedure, similar to the Thal serosal patch. No operative deaths occurred. The mean follow-up was 6.8 years, and only 1 patient was lost from this follow-up. Preoperative dysphagia, which was present in 100% of the patients, persisted only occasionally in 8%, and a significant gain in weight was recorded in 90% of the patients. In three patients epidermoid carcinoma developed 5 to 9 years after surgery. In one patient a severe gastroesophageal reflux with an esophageal ulcer developed. Radiologic studies demonstrated a significant increase in the diameter at the gastroesophageal junction and a decrease at the middle third of the esophagus (p less than 0.0001). The resting pressure of the lower esophageal sphincter showed a significant decrease, from 37 mm Hg to 10 mm Hg, after surgery (p less than 0.0001), when we analyzed 84 patients before and 68 patients after operation. The total length of this sphincter also decreased. The manometric evaluation of the lower esophageal sphincter pressure in the same 42 patients before, 2 months after, and 5 to 7 years after surgery demonstrated persistence of the low sphincter pressure. There was a significant increase in the amplitude of the esophageal waves, and the standard acid-reflux test demonstrated reflux into the esophagus in 19% of the patients. Final clinical evaluation showed excellent and good results in 92 of the 94 controlled patients.