[Surgical treatment of achalasia]

A total of 356 patients were treated for achalasia during a thirty eight years period, ranging from 1955 to 1993 the author presents his results and therapeutic recommendations. Since 1970, patients were treated in a standardized manner, using the transabdominal approach in 85,71% patients and the transthoracic approach in 14,29% pts. The operative technique for cardiomiotomy is described in detail for both approaches. To achieve good postoperative result it is necessary, to perform complete miotomy in a length of 6-8 cm. The miotomy should extend no less than 2 cm onto the stomach. All circular muscle fibers of the esophageal muscular layer should be severed. Antireflux procedure was added in all 294 patients operated since 1970. The demonstrated Dor fundoplication was done for a transabdominal approach and the Belsey mark IV antireflux procedure for the transthoracic approach. Reflux esophagitis was found in 12,82% of patients postoperatively while esophageal stricture in only 1,5% patients. In another group of 49 patients operated prior to 1970 postoperative check-up demonstrated the reflux esophagitis in 35,13% and an esophageal stricture in 5,4%. Antireflux procedure is an additional but important procedure in the treatment of achalasia. Inappropriate indications and an inadequate technique result in severe complications. Different approaches in the surgical management of achalasia are discussed.