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Ann Thorac Surg 1987;43:550-553
© 1987 The Society of Thoracic Surgeons

Articles

Reflux Patterns Following Limited Myotomy Without Fundoplication for Achalasia

Dorothy Thomson, M.D., J. Patrick Shoenut, B.Sc., Brian G. Trenholm, M. Eng., John M. Teskey, M.D., F.R.C.S.(C)*

From the Departments of Surgery and Medicine, St. Boniface General Hospital and the University of Manitoba, and the Department of Biomedical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada

Accepted for publication September 11, 1986.

* Address reprint requests to Dr. Teskey, 404-400 Tache Ave, Winnipeg, Manitoba, Canada R2H 3C3

Five patients with achalasia underwent limited myotomy without fundoplication. Surgery reduced mean lower esophageal sphincter resting pressure significantly (p < .05) from 31 ± 9.7 mm Hg to 16.1 ± 8.2 mm Hg. Twenty-four-hour ambulatory esophageal pH studies demonstrated that the percentage of time the pH in the distal esophagus was below 4 was similar whether the patient was upright or supine (6.6 ± 6.5% of total time upright vs. 9.1 ± 12.7% of total time). Reflux events that occur in the supine position may be significant because of their prolonged duration resulting from the absence of normal secondary peristalsis in the body of the esophagus. Patients with achalasia who have undergone esophagomyotomy without fundoplication do not appear to experience more reflux than control subjects with normal esophageal function.




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