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The Annals of Thoracic Surgery, Vol 43, 25-31, Copyright © 1987 by The Society of Thoracic Surgeons
RD Henderson, D Ryder and G Marryatt
Diffuse esophageal spasm (DES) is a rare disease, and its surgical
management is controversial. There are seven major reported series totaling
148 patients and six operative variations depending on the extent of
myotomy and whether or not a hernia repair should be added. There are no
five-year follow-up reports. In the present study of 34 patients followed
for at least five years, all had a myotomy from the apex of the chest
through the high-pressure zone and all had a total fundoplication hernia
repair, 16 with gastroplasty and 16 with a standard Nissen fundoplication.
The length of the completion fundoplication is reduced to less than 0.5 cm
to avoid problems of overcompetence. There were no operative deaths.
Follow-up is 100% by clinical history, 82.4% by radiology, and 61.8% by
manometry. Radiological follow-up showed no recurrence or reflux, although
1 patient had esophageal mucus retention. Thirty patients (88.2%) are
eating normally without dysphagia or spontaneous pain. Two patients (5.9%)
have mild dysphagia, and 1 of them also has mild spontaneous pain. One
patient has major residual dysphagia, which is being treated
conservatively, and 1 has required colon interposition. Good-quality
results have been achieved in 94% of patients now followed 5 to 10.7 years.
ARTICLES
Extended esophageal myotomy and short total fundoplication hernia repair in diffuse esophageal spasm: five-year review in 34 patients
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