Results of short- and long-segment cardioesophageal myotomy for achalasia

ABSTRACT

We report the results of a short- and long-segment cardiomyotomy for relief of the symptoms of achalasia. From 1997 to 2009, 41 patients [22 men, 19 women] with achalasia underwent cardiomyotomy. Patients were divided into 2 groups [short-segment group [SSG] and long-segment group [LSG]]. SSG include 22 patients with laparotomy and 8-cm short-segment myotomy and Dor fundoplication. LSG includes 19 patients with thoracotomy and 12-cm long-segment myotomy and Belsey partial fundoplication. Median follow up was 48 months [range 12-70 months]. Postoperative dysphagia improved in 20 patients in SSG and in 17 patients in LSG [P < 0.001]. Slow emptying sensation improved in 19 patients in SSG and in 16 patients in LSG postoperatively [P < 0.001]. Heartburn was present in 2 patients in SSG and 3 patients in LSG postoperatively [P = 0.179]. Radiologically, barium stasis decreased significantly from 88% to 25% in SSG and from 85% to 30% in LSG. The lower esophageal sphincter [LES] gradient decreased from 32 to 10 mmHg in SSG and from 34 to 14 mmHg in LSG [P < 0.001]. Short-segment cardiomyotomy reduces the LES gradient and relieves obstructive symptoms