Reflux control following myotomy in diffuse esophageal spasm

Area of Science:

• Gastroenterology
• Surgical Procedures
• Esophageal Motility Disorders

Background:

• Diffuse esophageal spasm (DES) is a primary esophageal motility disorder characterized by abnormal esophageal contractions.
• Surgical intervention is considered for refractory DES symptoms, often involving myotomy and anti-reflux procedures.
• Evaluating the efficacy of different surgical techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

• To investigate the outcomes of surgical management for diffuse esophageal spasm (DES).
• To compare the effectiveness of different hiatal hernia repair techniques combined with extended esophageal myotomy in DES patients.

Main Methods:

• Sixty-five patients with DES underwent diagnostic workup including history, radiology, manometry, and endoscopy.
• Surgical intervention consisted of extended myotomy to the chest apex and hiatal hernia repair.
• Four types of hiatal hernia repair were employed: Belsey procedure, partial fundoplication gastroplasty, total fundoplication gastroplasty, and Nissen procedure.

Main Results:

• The Belsey or partial fundoplication procedures were associated with a high incidence of persistent reflux.
• Total fundoplication resulted in no reflux but led to dysphagia in 7 patients (6 minor, 1 major).
• Myotomy with standard Nissen fundoplication yielded excellent results, with 13 patients asymptomatic and 2 experiencing minor dysphagia.

Conclusions:

• Extended myotomy combined with hiatal hernia repair is a viable surgical approach for DES.
• The Nissen fundoplication appears to be the most effective anti-reflux procedure in this context, offering favorable symptom relief for DES patients.
• Careful selection of the anti-reflux component is important to minimize postoperative complications like dysphagia.