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Esophagomyotomy for Esophageal Achalasia and Diffuse Esophageal Spasm

  • Jameson L. Chassin

Abstract

In esophageal achalasia the body of the esophagus is unable to produce organized peristaltic contractions, and the lower esophageal sphincter fails to relax following the act of swallowing. This combination of events results in partial obstruction. The esophagus dilates. The patient suffers from dysphagia, regurgitation, tracheal aspiration, and pneumonitis in advanced cases. Long-term relief from the symptoms of achalasia requires either hydrostatic dilatation of the lower esophagus or an esophagomyotomy. Both procedures result in interrupting the continuity of the circular muscle surrounding the distal esophagus. Sanderson, Ellis, and Olsen report that hydrostatic dilatation has been successful in relieving symptoms in 815 of their cases, of which 3.2% required emergency surgery for esophageal perforation. There were no deaths. On the other hand, Ellis, Kiser, Schlegel, Earlam, and others (1967) feel that surgical esophagomyotomy is the treatment of choice for esophageal achalasia. They experienced one death from malignant hyperthermia in 269 operations. There was only a 35 incidence of symptomatic reflux esophagitis. An additional 3% of cases experienced poor results in the form of either persistent or recurrent symptoms of dysphagia not related to gastroesophageal reflux. A majority of the patients having poor results from esophagomyotomy had previously under-gone unsuccessful treatment by hydrostatic dilatation or surgery. Using a similar technique of esophagomyotomy, Okike, Payne, and Newfeld also noted only a 3% incidence of postoperative reflux esophagitis in a study of 200 operations for achalasia done at the Mayo Clinic from 1967 to 1975. These authors report good or excellent results in 90% of their patients.

Keywords

Lower Esophageal Sphincter Circular Muscle Malignant Hyperthermia Lower Esophagus Esophageal Achalasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Ellis FH Jr, Kiser JC, Schlegel JF, Earlam RJ et al. (1967) Esophagomyotomy for esophageal achalasia: experimental, clinical, and manometric aspects. Ann Surg 166: 640PubMedCrossRefGoogle Scholar
  2. Ellis FH Jr, Gibb SP, Crozier RE (1980) Esophagomyotomy for achalasia of the esophagus. Ann Surg 192: 157PubMedCrossRefGoogle Scholar
  3. Henderson RD, Ryder DE (1982) Reflux control following myotomy in diffuse esophageal spasm. Ann Thorac Surg 34: 230PubMedCrossRefGoogle Scholar
  4. Leonardi HK, Shea JA, Crozier RE, Ellis FH Jr (1977) Diffuse spasm of the esophagus: clinical, manometric, and surgical consider-Esophagomyotomy for Esophagael Achalasia and Diffuse Esophageal Spasm ations. J Thorac Cardiovasc Surg 74: 736PubMedGoogle Scholar
  5. Murray GF (1980) Operation for motor dysfunction of the esophagus. Ann Thorac Surg 29: 184PubMedCrossRefGoogle Scholar
  6. Murray GF, Battaglini JW, Keagy BA, Starek PJK et al. (1984) Selective application of fundoplication in achalasia. Ann Thorac Surg 37: 185PubMedCrossRefGoogle Scholar
  7. Okike N, Payne WS, Newfeld DM et al. (1979) Esophagomyotomy versus forceful dila tation for achalasia of the esophagus: results in 899 patients. Ann Thorac Surg 28: 119PubMedCrossRefGoogle Scholar
  8. Sanderson DR, Ellis FH Jr, Olsen AL (1970) Achalasia of the esophagus: results of therapy by dilatation 1950–1967. Chest 58: 116PubMedCrossRefGoogle Scholar
  9. Skinner DB (1984) Myotomy and achalasia. Ann Thorac Surg 37: 183PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.New York University School of MedicineUSA
  2. 2.Booth Memorial Medical CenterFlushingUSA
  3. 3.University Hospital, New York University Medical CenterUSA
  4. 4.New York Veterans Administration HospitalUSA
  5. 5.Bellevue HospitalUSA

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