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

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Abstract
To determine the long-term clinical results after modifiedesophagomyotomy without an antireflux procedure for esophageal achalasia,the status of all patients undergoing this operation with a minimumfollow-up time of 10 years was reviewed; 81 such patients were operated onbetween January 1970 and January 1981. Thirteen patients were lost tofollow-up review permitting clinical evaluation during the past year of 68patients (84%) observed for a median of 13.6 years. Fifty-nine patients(87%) were improved by operation; 90% of the patients who underwent aprimary procedure were improved, whereas only 73% of patients undergoingreoperation benefited. Kaplan-Meier analysis of the results of all 81patients disclosed an improvement rate of 98.5% at 5 years, 95.6% at 10years, 85.8% at 15 years, and 67.3% at 20 years. When the level ofimprovement or lack thereof was analyzed, the percentage of excellentresults decreased from 54% to 32% (P = 0.02). The percentage of goodresults remained the same, whereas fair or poor results together increasedfrom 20% to 37% (P = 0.05). Neither age, sex, esophageal caliber, durationof symptoms, or previous therapy appeared to influence these results. Weconclude that limited esophagomyotomy without an antireflux procedureresults in persistent long-term improvement for the patient with esophagealachalasia. The level of improvement, however, decreases with the passage oftime, presumably because of persistent disease in the body of the esophagusleading to impaired esophageal emptying in some patients and late refluxesophagitis in other patients owing to poor esophageal clearance.

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