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KMID : 0376419770010000117
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Chonbuk University Medical Journal
1977 Volume.1 No. 0 p.117 ~ p.122
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Surgical Treatment of Achalasia of the Esophagus.
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Abstract
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Achalasia is a functional obstruction of the distal esophagus due to neuromuscular incoordination. There is no method to restore esophageal peristalsis until now, and the´ purpose for the treatment of achalasia is to relieve the esophageal obstruction.
The procedures which destroy or bypass the esophagogastric junction had a few complications such as reflux esophagitis, esophageal ulcer and hemorrhage, and modified Heller´s operation has been adopted as the procedure of choice for the moat patients with achalasia. Notwithstanding the general success of this operation there are two complications that detract from good results. One is recurrent obstruction of the esophagus and the other is peptic esophagitis.
This papr reports experience in the surgical treatment of eight cases , of achalasia from 1970 to Sep., 1976. The diagnosis was established by a combination of clinical symptoms, esophagography and esophagoscopy. Most commonly encountered symptoms were dysphagia regurgitation, chest pain or discomfort and weight loss.
These symptoms varied in duration from 8 months to 12 years with average duration of 5.3 years prior to operation. The four patients underwent modified Heller´s operation, and three of them have had excellent result and remaining o:.e was good. The 2 patients with peptic ulcer symptoms had a modified Heller operation with addition of vagotomy and pyloroplasty with excellent result.
A modified Heller´s operation and esophagofundopexy were done in the remaining 2 patients, and one have had excellent result and the other was good.
Myotomy failure may occur if incision is not extended sufficiently upward onto the dilated esophagus and if gastric sling fiber, hiatal supportive. structures and vagus nerve are injured.
Five patients had a transthoracic approach, 2 transabdominal and the other thoracoabdominal. In modified Heller´s operation, trartsthoracic approach was better in adequate exposure of the diseased distal esophagus.
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