SURGICAL TREATMENT OF CARDIOSPASM (ACHALASIA OF THE ESOPHAGUS)

Abstract

Achalasia is an absence of effective waves of peristalsis in the esophagus with failure of the lower esophageal sphincter to relax after deglutition. Medical treatment does not restore the normal motility, and mechanical dilation of the sphincter is attended by certain risks. Surgical intervention, consisting of an esophagomyotomy to relieve the obstruction caused by the contracted state of the sphincter, was carried out by abdominal route in 4 patients and by the thoracic route in 51. The longitudinal incision in the esophagus is intended to cut the circularly disposed muscle fibers and must not involve the mucosa. In most cases it is 8 to 12 cm. long, and it extends distally onto the stomach only far enough to insure the complete division of the distal esophageal musculature. Of 45 patients followed up more than nine months after operation, 38 (84.4%) had either a good or an excellent result. They remained essentially asymptomatic, regained their lost weight, and returned to full-time work. Results described as fair and poor were obtained in five and two patients respectively. Postoperative esophageal motility studies demonstrated the elimination of the supra hiatal portion of the inferior esophageal sphincter. It appeared that, by limiting the extent of the incision onto the stomach, enough of the subhiatal portion of the sphincter was preserved to prevent reflux esophagitis.