Currently conflicting opinions regarding the efficacy of esophagomyotomy alone as the preferred treatment for esophageal achalasia prompted this review of the results in 69 patients treated at the Lahey Clinic between January 1970 and January 1980. Preoperative symptoms were alleviated completely or partially in 92% of the 60 patients operated on more than 12 months ago and who were available for follow-up study (average: 42 months). Excellent or good results were achieved in 84% of patients. Only one of the poor results was due to reflux esophagitis. It is concluded that an antireflux procedure is not routinely necessary to prevent postoperative reflux esophagitis if the technique of esophagomyotomy follows certain specific guidelines.

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EDITORIAL SYNOPSIS A series of 56 patients with achalasia of the cardia included 16 with reflux after operation of whom seven were symptomless. A radiological technique which facilitated the detection of reflux was employed.The factors contributing to the development of reflux included duodenal ulceration, previous oesophageal operations, double and strip myotomies, and disruption of the hiatus. Of nine patients with reflux oesophagitis, five required further operative treatment. Careful pre-operative evaluation and the preservation of the hiatal mechanism are considered to be the most important factors in reducing the incidence of reflux. The long myotomy is considered to be necessary to ensure adequate oesophageal drainage. If it is placed on the lesser curve side of the oesophagus and stomach the risk of reflux is likely to be diminished.

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