OBJECTIVE: Report the long-term subjective and objective results of esophageal myotomy and fundoplication by thoracotomy in treating esophageal spastic disorders.
METHODS: From 1977 to 1995, 16 patients with esophageal spastic disorders underwent a myotomy with an added partial (12) or total (4) fundoplication. The median follow-up is 6 years. Assessments include clinical evaluation, esophagogram, radionuclide emptying, manometry, 24-hour pH, and endoscopy. From global results, patients with pure spastic disorders (8) were compared to patients with spastic disorders and an epiphrenic diverticulum (8).
RESULTS: There is no mortality and minimal morbidity. Results are summarized in table 1. Failure (Persistant symptoms, reflux damage or obstruction to emptying) was observed in 1 patient with a diverticulum at 9 years and in 4 patients with pure spastic disorder at 2, 3, 6, and 8 years after the operation (Log-rank test, p=0.029).
CONCLUSIONS: Long myotomy and fundoplication for spastic disorders: Reduces dysphagia and chest pain; Reduces distal peak contraction pressures and peristalsis; Decreases LES pressures. Improves LES relaxation. Spastic disorder patients with a diverticulum, when compared to pure spastic disorder patients, show better clinical results, better esophageal function.
Operative Results for Esophageal Spastic Disorders
Before Operation After Operation
Observation Divt(+) Divt(-) Divt(+) Divt(-) P Value
Dysphagia 7 8 1 3 =0.002
Chest Pain 6 6 0 3 =0.021
Stasis at 2 Min. (%) 26.1 39.0 20.2 44.6 >0.25
Body Contraction (mmHg) 70.1 78.8 35.0 33.4 <0.001
Body Peristalsis (%) 61.4 36.3 30.0 18.8 =0.016
LES Gradient (mmHg) 23.1 22.9 8.2 6.9 <0.001
LES Relaxation (%) 95.9 63.9 100.0 100.0 =0.005
Acid Exposure (time%) 10.0 0.0 6.3 11.5 >0.25
Esophagitis / Ulcer 0 1 2 2 >0.25
