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Ann Thorac Surg 1996;61:1110-1111
© 1996 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

F. Henry Ellis, Jr, MD, PhD

General Thoracic Surgery, Deaconess Hospital, 110 Francis St, Suite 2C, Boston, MA 02215.

The first 20% of the full text of this article appears below.

See also page 1106.

This article from the Department of Surgery of The University of Bologna on the timing of delayed complications after esophagomyotomy for achalasia provides us with an excellent review of a timely topic, carefully researched and well presented. Although others have noted a gradual deterioration in the level of improvement of patients after esophagomyotomy with the passage of time [1, 2], none have so carefully documented the precise timing of the symptomatic deterioration. Di Simone and associates do not specifically state what type of a Heller myotomy was performed, but I assume their approach was similar to that of other European surgeons, namely a transabdominal approach with some type of an antireflux maneuver, probably a Dor partial wrap.

Of their 129 patients, only 40 were followed up for more than 10 years. In 23 of the 129 patients, 1 with a stricture, reflux esophagitis developed postoperatively; in 8 of these 23 a columnar-lined esophagus developed. In 1 of these 8, an intramucosal adenocarcinoma was diagnosed 8 years postoperatively. Complications of gastroesophageal reflux disease, therefore, predominated among the causes of postoperative symptomatic deterioration, being detected after a mean of 76.5 months. Dysphagia was the next most common postoperative sequela, occurring in 18 patients (insufficient myotomy, 11; periesophageal scarring, 7), whereas megaesophagus was . . . [Full Text of this Article]


Related Article

Onset Timing of Delayed Complications and Criteria of Follow-up After Operation for Esophageal Achalasia
Massimo P. Di Simone, Valentino Felice, Antonia D'Errico, Francesco Bassi, Franco D'Ovidio, Stefano Brusori, and Sandro Mattioli
Ann. Thorac. Surg. 1996 61: 1106-1110. [Abstract] [Full Text]





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