Treatment of esophageal achalasia (cardiospasm) with diaphragmatic graft: report of 44 patients.

Results with the use of a diaphragmatic graft in the surgical relief of achalasia are reported for 44 patients. The operative technique involves construction of a pedicle flap of diaphragm the size of the muscular defect on the lower segment of the esophagus and suture of the transplanted diaphragmatic pedicle to the site of the esophageal muscular defect. Immediate operative results were good; there was only one complication, a case of pneumonia that was cured. Patients were followed from 3 months to 19 years. Two patients were lost to follow-up. Excellent results were obtained in 39 patients; 3 patients still had nausea and heartburn, but were better than before operation. This procedure has three advantages: (1) it prevents occurrence of fistula and diverticulum at the site of the esophageal muscular defect; (2) it effectively eliminates formation of restenosis due to scar and reflux esophagitis; and (3) it allows the cardia to recover its normal function and the esophagus to return to normal size at the site of operation.