A review of 74 patients with oesophageal achalasia: the results of Heller's cardiomyotomy, with and without Nissen fundoplication.

A survey is presented of 74 patients with achalasia of the the oesophagus treated surgically at the Royal Prince Alfred Hospital, Sydney, Australia. This survey spans a 27-year period. Thirty-nine patients underwent Heller's operation, 23 (58.9%) had excellent results six months after operation, and 17 (43.5%) still had excellent results more than two years after operation. This group had a high recurrence of symptoms due to oesophageal reflux (30.8%) and the development of strictures (20.5%) at the lower end of the oesophagus. Thirty-five patients underwent Heller's operation together with Nissen fundoplication. Thirty-two patients (91.4%) in this group had excellent results six months after operation, and 30 of these patients (85.7%) still had excellent results more than two years after operation. These results suggest that symptoms of oesophageal reflux and subsequent oesophageal stricture following Heller's operation for achalasia can be considerably reduced, if not prevented, by Nissen fundoplication--a reflux-preventing procedure.