Diaphragm valves reduce gastroesophageal reflux following cardiomyotomy for patients with achalasia

Abstract. Background : This study was designed to investigate the effect of a novel surgical method on cardia sphincter function and complication rates after Heller's cardiomyotomy for patients with achalasia. Methods : Forty-eight patients (19 males, mean age 34.0 ± 10.5 years, range, 12-58) were included in this study. A spindle diaphragm valve was used in the surgery to rebuild the cardiac sphincter function. The efficacy of the surgery was determined by clinical assessment of symptoms and lower esophageal sphincter pressure (LESP) measurements. Barium meal examination was also used to evaluate the efficacy. Results : The mean LESP before surgery was 41.3 ± 11.6 mmHg. It was reduced to 16.8 ± 3.7 mmHg and 17.5 ± 2.5 mmHg 3 and 12 months after surgery (P < 0.01). All patients were free of symptoms such as swallow difficulties or acid reflux during the follow up. However, barium swallow examination showed that 1 patient had mild reflux after the surgery. Clinical symptom scores on swallow difficulties/obstruction was reduced from 2.5 ± 0.65 before surgery to 0.06 ± 0.24 12 months after the surgery (P < 0.01).Conclusion : A spindle diaphragm valve used with Heller's cardiomyotomy was associated with a very low incidence of post-surgical complications, such as gastroesophageal reflux. This technique may be used in treating all patients with achalasia.