Heller's esophagomyotomy relieves dysphagia but does not restore esophageal peristalsis.
The myotomy may induce reflux. The addition of a 360° fundoplication may be hazardous with regard to the remaining aperistaltic esophagus.
In this study, doctors from Sweden compared the outcome in patients with uncomplicated achalasia. Patients underwent an anterior Heller's esophagomyotomy (H group) with or without an additional floppy Nissen fundoplication (H + N group).
The team evaluated 20 patients between 1984 and 1995.
Esophagitis, including Barrett's esophagus, was seen in 6 of 9 patients in the H group, but none in the H + N group.
|Patients had a significant improvement in dysphagia.|
|Diseases of the Esophagus|
No patient in the H + N group required postoperative continuous acid-reducing drugs.
The team found that 24-hour esophageal pH-studies (a median of 3.4 years after surgery) showed pathological reflux of 13% in the H group, and 0.15% in the H + N group.
They found that 1 patient with recurrent dysphagia in the H + N group later had an esophagectomy.
The doctors determined that the remaining patients had significant improvement of dysphagia, without symptoms of reflux, at 8 years follow-up.
Dr Falkenback's team concluded, "Heller's esophagomyotomy eliminates dysphagia, but can induce advanced reflux that requires medical treatment".
"The addition of a 360° fundoplication eliminates reflux without adding dysphagia in the majority of patients".
"[It] can be recommended for most patients with uncomplicated achalasia".