Results of Surgical Therapy of Achalasia with Three Different Techniques

From 1955 to date our group has adopted three different surgical techniques for the therapy of achalasia [1]. Until 1972 a long transabdominal esophagogastric myotomy (group AM) was performed in 72 patients. In 13 patients an antireflux procedure according to Lortat Jacob was also associated. A complete follow-up of these patients in 1972 showed that postoperative reflux was present in 41.1 %; the Lortat Jacob procedure had not reduced reflux. The second cause of failure in this group was periesophageal scarring (7.1 %). In order to avoid reflux and its serious complications, in 1973 we started to perform a transthoracic myotomy, limiting the incision on the stomach to only 1/2 cm [2]. However, our results were not satisfactory since the recurrence for insufficient myotomy was 20.8%. For these reasons, in 1979 we adopted a new technique, which consists of a long transabdominal esophagogastric myotomy with the addition of an anterior hemifun-duplication according to Dor [1]. In June 1986 a complete follow-up of the patients operated on from 1955 to June 1985 was completed to evaluate the results achieved with the three surgical techniques.