[Follow-up study of patients with achalasia treated by long myotomy + partial fundopexy + posterior fixation based on intraoperative manometry].

Long myotomy (6-8 cm) + partial fundopexy + posterior fixation with intraoperative manometry of the esophagus was performed in 23 cases of esophageal achalasia. These cases ranged from 24-72 years of age (average 42), 11 were males and 12 females. There were 19 primary cases and 4 postoperative cases of recurrence, and the period of their clinical courses ranged from 2 months to 23 years. Concerning the operative procedure, in 22 cases the approach was via an upper midline incision and 1 case the approach was via left thoraco-abdominal incision. Intraoperative manometry was performed to help in judging the extent of each manipulation. With the operative manipulation, the LESP is reduced to 13.0 +/- 6.0 mmHg (39% of the average preoperative value) and HPZ is elongated to 60.9 +/- 14.1 mm (155% of the average preoperative value). Moreover, post-operative manometry data resembled intra-operative data. The effectiveness of the procedure is judged on the basis of the chief complaints, esophagography, endoscopic examination, esophageal manometry and 24-hr pH monitoring. Patients are followed up at 2 weeks, 3 months and 1 year from the operation. Results showed 22 excellent cases (96.65%), 1 fair case (4.34%). These are better results than those of other reports that showed 50-60% excellent results and 30% good results (remaining slight passage disturbance). The reason for this difference is that we obtain sufficient LESP decompression effect (myotomy + submucosal layer ablation) based on intraoperative manometry. In the only case that we judged as fair (a reoperated case after Heller's operation) showed severe EGR totalling 213 min. on 24-hr pH monitoring of the esophagus in the postoperative period and was erosion also seen in the lower esophagus endoscopically. In this case, the LESP was 6.0 mmHg and its HPZ is 27.0 mm, showing a higher HPZ than the non-reflux group. Among the non-reflux group, LESP was as low as 6.0 mmHg, and this case had a remarkable long HPZ of 57.0 mm. In conclusion, even though the LESP is low, it is possible to prevent reflux if the HPZ is sufficiently long.