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Ann Thorac Surg 1994;58:1343-1347
© 1994 The Society of Thoracic Surgeons

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Articles

Long-term results in surgically managed esophageal achalasia

Division of Thoracic Surgery, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada

^_* Address reprint requests to Dr Pearson, Toronto General Hospital, Eaton Wing 10-233, Toronto, Ontario, Canada M5G 2C4.

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 [equation] patients (95%) at 1 year, [equation] (77%) at 5 years, [equation] (68%) at 10 years, [equation] (69%) at 15 years, and [equation] (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.

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