Pathophysiology of Motility Disordors in Esophagogastric Junction and Indication of Surgical Treatment

Tatsuyuki Kawano, Mitsuo Endo, Hiroshi Habu, Kunihide Yoshino, Kimiya Takeshita, Tohru Takiguchi, Shigeru Yamazaki, Yasushi Satoh

First Department of Surgery, Tokyo Medical and Dental University School of Medicine

The pathophysiologic state of 29 patients with reflux esohagitis including 8 post-gastrectomy patients and 14 patients with achalasia was evaluated manometrically, and operative indications for them are discussed. Conservative treatment for patients with longitudinal type reflux esophagitis was more effective than for patients with the marginal type, and the manometric findings suggest that the derangement in the motility was limited to the area of definite esophagitis. Roentgenologic and manometric study revealed the grade of disorder in achalasia, and intraoperative manometric study revealed the meaning of each surgical procedure. Eight patients with reflux esophagitis were treated by Nissen's procedure, and 13 patients with achalasia were operated on by a modified Jekler-Lhotka method. Good clinical results were obtained with improvement of function of the esophagogastric junction. Surgical treatment should be considered in cases of these diseases that are poorly controlled with conservative therapy, because the surgical treatment is safe and reliable, and the effect of the operation is continuous.

Key words
reflux esophagitis, achalasia, indication of surgical treatment

Reprint requests
Tatsuyuki Kawano First Department of Surgery, Tokyo Medical and Dental University School of Medicine
1-5-45 Yushima, Bunkyo-ku, Tokyo, 1l3 JAPAN

Accepted
June 13, 1990

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