Oesophagocardiomyotomy and antireflux procedures.

Although oesophagocardiomyotomy has been the method of choice for surgical treatment of achalasia cardiae for several decades, there are still great discrepancies in the technical details of the procedure as performed in different centres. This is one of the main explanations for the diverging results reported, particularly with regard to the incidence of postoperative gastro-oesophageal reflux. Sixty-three patients underwent primary oesophagocardiomyotomy with a total length of 12 cm, including incision of about 2 cm onto the stomach. Forty-one patients were not examined preoperatively for conditions now recognized as predisposing to reflux and were managed with oesophagocardiomyotomy only, except one patient. Eight patients developed severe reflux complications from 1 to 5 years (mean 2 years) after the operation. In 11 out of 22 patients examined preoperatively for such conditions, Heller's operation was combined with an antireflux procedure. The results were good in all patients and pathological gastro-oesophageal reflux was not detected in any of the 22 patients during a follow-up period of 2 to 7 years (mean 4 years). It is concluded that oesophagocardiomyotomy should be combined with an antireflux procedure in selected patients. The indications for an antireflux procedure are discussed.