[Resection therapy of advanced achalasia]

Achalasia of the esophagus is combination of dysfunction of the lower esophageal sphincter and disorder of the peristaltic movement of the esophageal body. Both components influence one another in a negative way, but the first usually prevails. That is why satisfactory and long-term results can be obtained in most of patients with non-advanced achalasia by Heller's myotomy. In a small group of patients with disease of megaesophagus-type (disorder of the motility of the esophageal body prevails) and in patients in which their disease reach for various reasons the stage of advanced (decompensated) achalasia, the resection-surgery is etiopatogeneticly justified. At the Ist and IInd surgical clinic in Olomouc 331 patients with achalasia have been operated so far. 29 patients treated by resection of a shorter or longer portion of the aboral esophagus, in 2 patients the whole thoracic esophagus was extirpated without thoracotomy. Resection was in principle indicated as secondary treatment. To substitute the esophagus the stomach in various operative modifications was used in two thirds of the patients, in the remaining patients interposition by a segment of the small or large intestine was carried out.