Journal of Gastrointestinal Surgery

, Volume 11, Issue 9, pp 1134–1137 | Cite as

Esophagectomy for End Stage Achalasia

  • Stephen M. GlatzEmail author
  • J. David Richardson


Esophageal myotomy is the standard primary therapy for achalasia. However, reports on long-term results of myotomy have suggested a deterioration of outcome over time with many patients presenting with end stage disease several years after esophagomyotomy. Eight patients who had previously undergone esophagomyotomy for achalasia presented with recurrent or worsening symptoms, and after preoperative evaluation, were treated by esophagectomy via laparotomy and right thoracotomy. The mean age at the time of myotomy was 52 years (range 18 to 62 years), and the mean time until esophagectomy was 12.5 years (range 2 to 18 years) after the initial myotomy. The median time until esophagectomy was performed after myotomy was 14 years. All patients in this series gained weight (mean, 23 pounds; range, 9 to 42 lbs) following esophagectomy, and none of the patients complained of dysphagia at follow-up or developed stricture. There were no major complications (including anastomotic leak) or deaths in this series. Five of the patients have been followed a mean of six years and remain well. Esophagectomy is a safe and appropriate treatment option in the setting of recurrent and end stage achalasia.


Achalasia Esophagomyotomy Esophagectomy 


  1. 1.
    Woltman TA, Pellegrini CA, Oelschlager BK. Achalasia. Surg Clin North Am 2005;85(3):483–493 June.PubMedCrossRefGoogle Scholar
  2. 2.
    Vaezi MF, Richter JE, Wilcox CM, Schroeder PL, Birgisson S, Slaughter RL, Koehler RE, Baker ME. Botulinum toxin versus pneumatic dilation in the treatment of achalasia: a randomized trial. Gut 1999;44(2):231–239 Feb.PubMedCrossRefGoogle Scholar
  3. 3.
    Echardt VF, Goekel I. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 2004;53(5):629–633 May.CrossRefGoogle Scholar
  4. 4.
    Heller E. Extramukose cardioplastik beim chronischen cardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir 1913;27:141–149.Google Scholar
  5. 5.
    Anselmius M, Pedikis G, Hinder RA, et al. Heller myotomy is superior to dilatation for the treatment of early achalasia. Arch Surg 1997;132(3):233–240 Mar.Google Scholar
  6. 6.
    Duffy PE, Awad Z, Filipi C. The laparoscopic reoperation of failed Heller myotomy. Surg Endosc 2003;17(7):1046–1049 Jul.PubMedCrossRefGoogle Scholar
  7. 7.
    Holzman MD, Sharp K, Ladipo J, Eller R, Holcomb G III, Richards W. Laparoscopic surgical treatment of achalasia. Am J Surg 1997;173(4):308–311 Apr.PubMedCrossRefGoogle Scholar
  8. 8.
    Codispoti M, Soon S, Pugh G, Walker W. Clinical results of thoracoscopic Heller’s myotomy with partial fundoplication for the treatment of achalasia. Eur J Cardiothorac Surg 2003;24(4):620–624 Oct.PubMedCrossRefGoogle Scholar
  9. 9.
    Swanstrom LL, Pennings J. Laparoscopic esophagomyotomy for achalasia. Surg Endosc 1995;9(3):286–290 Mar.PubMedCrossRefGoogle Scholar
  10. 10.
    Iqbal A, Tierney B, Haider M, Salinas V, Karu A, Turaga K, Mittal S, Filipi C. Laparoscopic re-operation for failed Heller myotomy. Dis Esophagus 2006;19(3):193–199.PubMedCrossRefGoogle Scholar
  11. 11.
    Gaissert HA, Lin N, Wain J, Fankhauser G, Wright C, Mathisen D. Transthoracic Heller myotomy for esophageal achalasia: analysis of long term results. Ann Thoracic Surg 2006;81(6):2044–2049 Jun.CrossRefGoogle Scholar
  12. 12.
    Bonatti H, Hinder RA, Klocker J, et al. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg 2005;190(6):874–878 Dec.PubMedCrossRefGoogle Scholar
  13. 13.
    Malthaner R, Todd TR, Miller L, Ranson FG. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg 1994;58:1343–1347.PubMedCrossRefGoogle Scholar
  14. 14.
    Bloomston M. Early results of laparoscopic Heller myotomy do not necessarily predict long-term outcome. Am J Surg 2004;187(3):403–407 Mar.PubMedCrossRefGoogle Scholar
  15. 15.
    Torbey CF, Achkar E, Rice TW, Baker M, Richter JE. Long-term outcome of achalasia treatment: need for closer follow-up. J Clin Gastroenterology 1999;28(2):125–130 Mar.CrossRefGoogle Scholar
  16. 16.
    Orringer MB, Sterling MC. Esophageal resection for achalasia: indications and results. Ann Thorac Surg 1989;47:340–345.PubMedCrossRefGoogle Scholar
  17. 17.
    Ellis HF, Crozier RC, Gibb SP. Reoperative Achalasia Surgery. J Thorac Cardiovascular Surg 1986;92:859–865.Google Scholar
  18. 18.
    Fekete F, Breil M, Tossen J. Reoperation after Heller’s operation for achalasia and other motility disorders of the esophagus: a study of eighty-one reoperations. Int Surg 1982;67:103–110.PubMedGoogle Scholar
  19. 19.
    Devaney EJ, Orringer MB. Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 2001;72:854–858.PubMedCrossRefGoogle Scholar
  20. 20.
    Miller DL, Allen MS, Trastek VF, Deschamps C, Pairolens P. Esophageal resection for recurrent achalasia. Ann Thorac Surg 1995;60:922–926.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  1. 1.Department of Surgery, School of MedicineUniversity of LouisvilleLouisvilleUSA

Personalised recommendations