Reflux control following myotomy in diffuse esophageal spasm

Sixty-five patients with diffuse esophageal spasm (DES) were investigated by history, radiology, manometry, and endoscopy prior to surgical management. At operation they underwent extended myotomy to the apex of the chest, including the high-pressure zone; in addition, all had hiatal hernia repair. Four types of repair were used: the Belsey procedure, partial fundoplication gastroplasty, total fundoplication gastroplasty, and the Nissen procedure. With the Belsey or the partial fundoplication, there was a high incidence of continued reflux. With the total fundoplication procedure, there was no reflux; however, 6 patients had minor dysphagia and 1 had major dysphagia. With myotomy and a standard Nissen fundoplication, 13 patients were asymptomatic and 2 had minor dysphagia; none had major residual symptoms.