The effectiveness of an anterior partial fundoplication in reflux protection of the myotomized oesophagus for achalasia

Abstract

49 patients who underwent transabdominal oesophagocardiomyotomy and an anterior partial fundoplication for achalasia have been followed for at least 5 years (range 5-13 years). The clinical results were good to excellent in all patients. Mild and occasional symptoms of reflux were present in a subset of patients (< 10%). Endoscopy revealed a high incidence of oesophagitis 1 year after surgery (28.6%). Oesophagitis was, however, mild (grade I) in all cases but one (grade II). These patients were instructed to follow an anti-reflux programme. At endoscopy 2 and 3 years after surgery the incidence of oesophagitis declined to 18.4 and 16.3% respectively with no changes in findings afterwards. No cases of progressive reflux damage or Barrett's oesophagus were detected. At 24-h pH studies performed 5 or more years after surgery pathological reflux was detected in one of 27 patients studied. Providing excellent relief of dysphagia with mild, easily controlled reflux without any tendency to progress in a subset of patients, anterior partial fundoplication deserves consideration for reflux protection of the transabdominally myotomized oesophagus for achalasia.