Functional results after extended myotomy for diffuse oesophageal spasm.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Motility Disorders

Background:

• The surgical management of diffuse oesophageal spasm (DOS) is debated.
• Extended myotomy aims to improve functional outcomes in severe DOS cases.

Purpose of the Study:

• To evaluate the functional results of extended myotomy with anterior fundoplication in patients with severe diffuse oesophageal spasm.

Main Methods:

• Prospective study of 20 patients with severe DOS undergoing 14 cm esophageal and 2 cm gastroesophageal junction myotomy with anterior fundoplication.
• Functional outcomes assessed using dysphagia, chest pain, and overall clinical scores (0-12) pre- and post-operatively.
• Median follow-up was 50 months.

Main Results:

• Significant reductions in median preoperative to postoperative scores for overall clinical (6 to 1), dysphagia (2 to 0), and chest pain (2 to 0).
• Excellent or good results achieved in 16/20 patients for overall score, 18/20 for dysphagia, and 20/20 for chest pain.
• Two patients experienced postoperative gastro-oesophageal reflux.

Conclusions:

• Extended myotomy combined with anterior fundoplication is an effective surgical treatment for severe diffuse oesophageal spasm.
• The procedure yields excellent medium-term functional results, notably improving dysphagia and chest pain.