[Improved gastric patch method for esophagocardioplasty in esophageal achalasia]

We performed esophagocardioplasty with the gastric patch (original GP) as the treatment of first choice in patients with esophageal achalasia. However, postoperative reflux esophagitis occurred in many due to secretory dysfunction of the gastric mucosa implanted in the mediastinum. We therefore developed two modifications of the gastric patch technique (GP II and GP III) which do not involve implantation of the gastric mucosa in the esophagus. Twenty-three patients have undergone the modified GP II procedure in our institution. Postoperative changes in the esophagus were examined fluoroscopically, and it was found that esophageal diameter increased from an average 2.9 +/- 0.6 cm to 5.2 +/- 1.0 cm at an average follow-up of 7.1 months (p < 0.01). All 23 patients experienced amelioration of symptoms, even though some reddening was still present in the lower esophagus, with a maximum follow-up of 8 years. Based on these results, the modified GP procedures are an acceptable open surgery modality for esophagocardioplasty in esophageal achalasia.