Surgical treatment of patients with esophageal achalasia

Beetween 1979 and 1992, 18 patients with esophageal achalasia underwent surgical treatment in our Department of Surgery II. The operative procedure was mainly selected according to the X-ray type while also taking the seriousness of symptoms into consideration. There were 9 patients with spindle type: An anterior myotomy was performed in 7 patients, while the remaining 2 patients exceptionally underwent a subtotal esophagectomy because of the presence of esophageal carcinoma. A fundic patch procedure was performed in 9 patients with either non-spindle-type achalasia or with critical regurgitation. A follow-up study was done by esophagram and endoscopy, and the postoperative quality of life was also evaluated by a questionnaire interview. There were neither procedural complications nor postoperative deaths. In the questionnaire interview of 16 patients, excluding the 2 patients with esophageal carcinoma, the improvement rates of dysphagia, regurgitation, and coughing were 100%, while the improvement rates for heartburn and retrosternal pain were 84.5 and 88.9%, respectively. No evidence of a recurrence of achalasia was detected after an average follow-up period of 8.8 (range 1-13) years. We believe that both anterior myotomy and fundic patch operation are still useful options for the treatment of esophageal achalasia, but only when the patients can be adequately selected on the basis of both the symptoms as well as the objective findings.