HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ellis, F. H. Articles by Heatley, G. J. Search for Related Content PubMed PubMed Citation Articles by Ellis, F. H., Jr Articles by Heatley, G. J.

European Journal of Cardio-Thoracic Surgery, Vol 6, 86-89, Copyright © 1992 by European Association for Cardio-thoracic Surgery

ARTICLES

Ten to 20-year clinical results after short esophagomyotomy without an antireflux procedure (modified Heller operation) for esophageal achalasia

FH Ellis Jr, E Watkins Jr, SP Gibb and GJ Heatley
Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, Burlington, Mass.

To determine the long-term clinical results after modified esophagomyotomy without an antireflux procedure for esophageal achalasia, the status of all patients undergoing this operation with a minimum follow-up time of 10 years was reviewed; 81 such patients were operated on between January 1970 and January 1981. Thirteen patients were lost to follow-up review permitting clinical evaluation during the past year of 68 patients (84%) observed for a median of 13.6 years. Fifty-nine patients (87%) were improved by operation; 90% of the patients who underwent a primary procedure were improved, whereas only 73% of patients undergoing reoperation benefited. Kaplan-Meier analysis of the results of all 81 patients disclosed an improvement rate of 98.5% at 5 years, 95.6% at 10 years, 85.8% at 15 years, and 67.3% at 20 years. When the level of improvement or lack thereof was analyzed, the percentage of excellent results decreased from 54% to 32% (P = 0.02). The percentage of good results remained the same, whereas fair or poor results together increased from 20% to 37% (P = 0.05). Neither age, sex, esophageal caliber, duration of symptoms, or previous therapy appeared to influence these results. We conclude that limited esophagomyotomy without an antireflux procedure results in persistent long-term improvement for the patient with esophageal achalasia. The level of improvement, however, decreases with the passage of time, presumably because of persistent disease in the body of the esophagus leading to impaired esophageal emptying in some patients and late reflux esophagitis in other patients owing to poor esophageal clearance.

This article has been cited by other articles:

				H. A. Gaissert, N. Lin, J. C. Wain, G. Fankhauser, C. D. Wright, and D. J. Mathisen Transthoracic Heller Myotomy for Esophageal Achalasia: Analysis of Long-Term Results Ann. Thorac. Surg., June 1, 2006; 81(6): 2044 - 2049. [Abstract] [Full Text] [PDF]

				A. Pirtniecks, L.F Smith, and J.A.C. Thorpe Autonomic dysfunction in non-specific disorders of oesophageal motility Eur. J. Cardiothorac. Surg., February 1, 2000; 17(2): 101 - 105. [Abstract] [Full Text] [PDF]

				A. E. Spiess and P. J. Kahrilas Treating Achalasia: From Whalebone to Laparoscope JAMA, August 19, 1998; 280(7): 638 - 642. [Abstract] [Full Text] [PDF]

				F. H. Ellis Jr Invited Commentary Ann. Thorac. Surg., April 1, 1996; 61(4): 1110 - 1111. [Full Text]

				J. M. Streitz Jr., F. H. Ellis Jr., W. A. Williamson, M. E. Glick, J. A. Aas, and R. L. Tilden OBJECTIVE ASSESSMENT OF GASTROESOPHAGEAL REFLUX AFTER SHORT ESOPHAGOMYOTOMY FOR ACHALASIA WITH THE USE OF MANOMETRY AND pH MONITORING J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 107 - 113. [Abstract] [Full Text]

				D. L. Miller, M. S. Allen, V. F. Trastek, C. Deschamps, and P. C. Pairolero Esophageal Resection for Recurrent Achalasia Ann. Thorac. Surg., October 1, 1995; 60(4): 922 - 925. [Abstract] [Full Text]