Follow up Study of Modified Jekler's Operation Based on Intraoperative Manometry in Achalasia

Hiroko Ide, Fumihide Kotou, Atsushi Nogami, Noriyuki Kubota, Tomoko Hanashi, Ken Endo, Tsutomu Nakamura, Yuji Tsukahara, Masahiko Muroi, Reiki Eguchi, Ataru Kobayashi, Fujio Hanyu

Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical College

From 1986, we treated 26 cases of achalasia by modified Jekler's operation (long myotomy + partial fundopexy + posterior fixatin) based on intraoperative manometry and obtained satisfactory results (Excellent 96.8%). The lower esophageal high pressure zone (HPZ) value during laparotomy was almost the same as the preoperative levels and the intraoperative lower esophageal sphincter pressure (LESP) decreased to 38% of the preoperative level after long myotomy + manipulation of the submucosal ablation. The length of HPZ was increased to about 150% of the preoperative length by fundopexy + posterior fixation. Postoperative esophageal manometry and 24-hr pH monitoring data reveal that the occurrence of postoperative reflux esophagitis is related to the short length, rather than to the new low LESP, and posterior fixation of Hill's procedure is useful for producing a long streched abdominal esophagus and prevent postoerative reflex esophagitis. The modified Jekler's method is applicable to any stage of achalasia for simplicity and safety and shows better results than those of former methods. Intraoperative manometry in achalasia is effective for improving postoperative long-term results.

Key words
modified Jekler's operation, intraoperative manometry in achalasia, Hill's procedure

Reprint requests
Hiroko Ide Department of Surgery, Institute Gastroenterology, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku, Tokyo, 162 JAPAN

Accepted
June 13, 1990

To read the PDF file you will need Abobe Reader installed on your computer.