[Esophagocardiomyotomy or modified Heller technique, through the thorax, for the treatment of achalasia].

BACKGROUND

Since 1913 surgical myotomy has been an effective method for patients with esophageal achalasia and until today there is controversy between pneumatic dilatation or surgery and between the abdominal or thoracic approach for Heller's procedure.

AIMS

To find out the long-term results with thoracic short esophagomyotomy without an antireflux procedure for esophageal achalasia.

METHODS

The charts of 31 patients with achalasia operated of thoracic Heller's myotomy between 1986 and 1995 were reviewed in retrospective fashion.

RESULTS

Demographic and clinical data were similar to those reported in the English literature. Twenty five patients received medical or endoscopic treatment with poor results. Prior abdominal Heller's myotomy was performed in 5 patients, 25 per cent of patients developed postoperative complications, there was no operative mortality. The mean follow-up period was 4 years and 93.6 per cent of patients showed good to excellent results; in this group 3 patients (9.7 per cent) reported sporadic dysphagia. Two patients (6.4 per cent) had gastroesophageal reflux.

CONCLUSIONS

The thoracic esophagomyotomy is a safe procedure for esophageal achalasia, it is easy to perform, there are several technical advantages over the abdominal approach, an antireflux procedure is not necessary and in the long-term follow-up a large number of good-to-excellent results may be obtained with both surgical approaches.