Analysis On Heller Myotomy Operation For Oesophageal Achalasia

Objective: To objectively assess various operative procedures for achalasia, and to provide basis for selecting the appropriate type of surgery.Methods: Between January 1998 and September 2007,204 patients with achalasia underwent Heller's myotomy in the Forth Hospital of Hebei Medical University.There were 87 male and 117 females, with a mean age of 33.9 years (rage 8 to 69). The patients had varying degrees of dysphagia, and mean duration of symptoms was 4.7 years (range 1 month to 37 years). All patients had a dilated esophagus with bird beak appearance on Upper gastrointestinal barium meal examination. 142 patients's routine esophagoscopy examination result revealed varying degrees of esophageal expansion, 98 cases visible turbid liquid and food retention, 32 cases saw inflammatory changes of esophageal mucosa. The curative effect of operation were evaluated as excellent(symptom disappears completely)and good(light symptom does not need to deal with)and fair(light symptom need to deal with occasionally)and poor(symptom is obvious, need frequently deal with).Results: Outcomes assessed by patient questionnaires revealed excellent relief of dysphagia in 42 patients(20.6%),good relief in28patients(71.6%),fair relief in 14(6.9%),and a poor result in 2 (1%). The overall excellent or good results were 92.2%, this percentage is 94.9% in thoracic surgery group and 91.5% in abdominal surgery group (P=0.711).This percentage is 90.3% in Heller's myotomy without anti reflux group and 93.5% in Heller + anti-reflux surgery group (P = 0.405).The reflux rate of pure modified Heller operation through thoracic approach is not higher than through abdominal approach(P = 0.956).The reflux rate of pure modified Heller operation is higher than Heller operation added anti-reflux procedure(P = 0.016). Conclusion: The therapeutic efficacy and postoperative reflux rate of modified Heller through abdominal approach and through thoracic approach had no Statistical difference; The therapeutic efficacy of additional anti-reflux procedure and simply modified Heller had no statistical difference, and additional anti-reflux procedure markedly decreased the incidence of postoperative reflux, so it is worthy to be extended in clinical practice.