Oesophagomyotomy with partial fundoplication for achalasia of the cardia

ABSTRACT

Twelve patients with achalasia of the cardia were surgically treated over a four-year period. The diagnosis was established through clinical, radiological and endoscopic findings, while oesophageal manometry was performed in 9 cases. All patients underwent oesophagomyotomy with; anterior partial fundoplication in 5 cases and posterior partial fundoplication in 7 cases. There were no peri-operative mortality or significant morbidity among these patients. One year after surgery, the outcome was excellent in 8 cases [66.7%] and good in 3 cases [25%] while, one patient with mega-oesophagus failed to improve and underwent oesophageal resection and colonic replacement. Postoperative radiological studies showed non-reflux of barium in the examined cases while, oesophageal manometry revealed the presence of a small high pressure zone in the 8 cases examined, that mostly prevented the reflux but did not cause postfundoplication oesophageal obstruction. Follow-up [mean +/- s.e was 2.4 +/- 0.2 years] revealed no cases of recurrent dysphagia or symptomatic gastro-oesophageal reflux. The success rate of this series was 91.7% and as the procedure is simple, needs no special skills and obviates the need for thoracotomy or to excise part of the oesophageal muscle, we recommend it as a primary management of achalasia of the cardia