Transabdominal esophagomyotomy and partial fundoplication for treatment of achalasia

The most common surgical treatment for achalasia is a modified anterior extramucosal esophagomyotomy. Unfortunately, a poor outcome may result secondary to recurrent dysphagia or gastroesophageal reflux. The reported incidence of reflux is 4 to 50 per cent. Our treatment for achalasia is an esophagomyotomy carried onto the cardia combined with a partial gastric fundoplication. Of 22 patients who presented with achalasia and moderate to severe symptoms of dysphagia and odynophagia, 19 had this procedure performed. Of these 19 patients, only two required a second procedure (postoperative dilatation) for recurrent symptoms. All three patients who had a full fundoplication required further surgical correction. Although fundoplication has been condemned in the past as treatment of achalasia to avoid the postoperative outcome of reflux, we have been successful with a partial fundoplication added to the standard esophagomyotomy. Given the fine line that needs to be tread to prevent recurrent signs and symptoms of achalasia or reflux when performing esophagomyotomy, our procedure offers a viable alternative to transthoracic esophagomyotomy alone.