Long-term results in surgically managed esophageal achalasia

Abstract

The long-term clinical results of surgical treatment for esophageal achalasia were reviewed in 35 patients having a minimum follow-up of 10 years. Group A (n = 22) are those patients whose first procedure (myotomy and Belsey partial fundoplication) was done at our hospital. Group B (n = 13) are those who had undergone one or more previous operations elsewhere. In group A good to excellent results occurred in 21 / 22 patients (95%) at 1 year, 17 / 22 (77%) at 5 years, 15 / 22 (68%) at 10 years, 11 / 16 (69%) at 15 years, and 6 / 9 (67%) at 20 or more years. Two patients underwent early reoperation (2 and 5 years) for dysphagia due to incomplete myotomy. Three patients underwent esophagectomy (7, 19, and 23 years) and one patient underwent an antrectomy and Roux-en-Y diversion (23 years) for late-onset complications of reflux. Three of 13 group B patients had had multiple prior operations and had severe reflux damage at presentation and underwent immediate esophagectomy. Ten patients had one or more conservative operations in our hospital, and 4 of these eventually required esophagectomy for disabling reflux. Therefore, there were 10 patients (groups A + B) who underwent esophageal resection, all but 1 of whom had endoscopically documented reflux and 5 of whom had peptic strictures. Six of the 10 esophagectomies were performed more than 10 years (13 to 23 years) after the first operation. These data show that there is a deterioration of initially good results after surgical myotomy and hiatal repair for achalasia due to the late development of disabling reflux disease.