[Surgical aspects of treatment of esophageal achalasia]

Based on experience assembled with surgical treatment of 88 patients with achalasia of the oesophagus in 1980-1988 the authors assume that patients in the second stage of the disease where dilatation treatment produced only temporary relief lasting several weeks and all patients in the third stage of the disease are indicated for treatment. The authors prefer the abdominal approach to the cardia and distal oesophagus as the cardia has an intraabdominal localization. It is also possible to treat other intraabdominal diseases and an antireflux operation can be easily performed. Patients tolerate laparotomy better than thoracotomy. In the author's opinion myotomy extending over 8 cm is sufficient Its protraction to the dilated portion of the oesophagus is not necessary. The antireflux operation is made only when before operation gastrooesophageal reflux was present or where during operation the oesophageal mucosa is open or where mobilization in the area of the oesophageal hiatus damaged several anatomical antireflux structures. Resection of the oesophagus in the IIIrd stage of the disease is exceptional in the authors' opinion.