Esophagomyotomy for Esophageal Achalasia and Diffuse Esophageal Spasm

Abstract

In esophageal achalasia the body of the esophagus is unable to produce organized peristaltic contractions, and the lower esophageal sphincter fails to relax following the act of swallowing. This combination of events results in partial obstruction. The esophagus dilates. The patient suffers from dysphagia, regurgitation, tracheal aspiration, and pneumonitis in advanced cases. Long-term relief from the symptoms of achalasia requires either hydrostatic dilatation of the lower esophagus or an esophagomyotomy. Both procedures result in interrupting the continuity of the circular muscle surrounding the distal esophagus. Sanderson, Ellis, and Olsen report that hydrostatic dilatation has been successful in relieving symptoms in 81% of their cases, of which 3.2% required emergency surgery for esophageal perforation. There were no deaths. On the other hand, Ellis, Kiser, Schlegel, Earlam, and others (1967) feel that surgical esophagomyotomy is the treatment of choice for esophageal achalasia.