ESOPHAGEAL RESECTION FOR RECURRENT ACHALASIA

Background. This study examined esophageal resection as treatment for recurrence or treatment complications of achalasia. Methods. From 1976 through 1992, 37 patients (20 men and 17 women) underwent esophageal resection after initial surgical treatment for achalasia. The median age was 56 years (range, 19 to 84 years). Initial surgical treatment consisted of modified Heller myotomy in 28 patients, combined myotomy and antireflux procedure in 6, and antireflux procedure alone in 3. Twenty-six patients required an additional surgical procedure before esophageal resection (70.3%). Indication for esophageal resection was obstructive symptoms in 30 patients, cancer in 3, bleeding in 2, and perforation during dilation in 2. Reconstruction was established with the stomach in 26 patients, colon in 6, and small bowel in 5. Anastomosis was at the cervical level in 20 patients (54.1%) and intrathoracic in 17 (45.9%). Results. There were two operative deaths (5.4%), both caused by intraoperative hemorrhage during transhiatal resection. Twelve patients (32.4%) had complications, which included cardiac dysrhythmia in 3, cervical anastomotic leak in 2, transient vocal cord paralysis in 2, pneumonia in 2, pulmonary embolus in 2, and reexploration for bleeding in 1. Follow-up was complete in all patients and ranged from 1.4 to 16 years (median, 6.3 years). Excellent or good long-term functional results were present in 32 patients (91.4%). Conclusions. Esophageal resection provides reasonable long-term functional results in patients with recurrence or treatment complications of achalasia. In our experience, transhiatal resection is associated with increased morbidity and mortality.