An antireflux procedure is critical to the long-term outcome of esophageal myotomy for achalasia

Abstract

Based on these findings, the following conclusions may be drawn: 1. Abdominal myotomy combined with fundoplication provides excellent symptomatic out-come both short and long term in patients with achalasia. 2. Gastroesophageal reflux disease and its sequelae are significant long-term problems in postmyotomy patients with achalasia. 3. The preponderance of evidence suggests that pH-proved reflux is minimized by the addition of a partial fundoplication. 4. Approximately one third of patients treated with dilatation or myotomy without fundoplication will have pH-proved reflux. 5. Laparoscopic myotomy plus fundoplication results in less reflux (< 10%) than myotomy without an antireflux procedure (30% +). 6. Symptoms are not a reliable guide for detecting reflux. 7. Postoperative pH studies are necessary to detect patients with pathologic gastroesophageal reflux. 8.Reflux is uncommon in patients who have not undergone dilatation or surgery.