Diffuse esophageal spasm (DES) is a
rare disease, and its surgical management is controversial. There are seven major reported series totaling 148 patients and six operative variations depending on the extent of
myotomy and whether or not a
hernia repair should be added. There are no five-year follow-up reports. In the present study of 34 patients followed for at least five years, all had a
myotomy from the apex of the chest through the high-pressure zone and all had a total
fundoplication hernia repair, 16 with
gastroplasty and 16 with a standard Nissen
fundoplication. The length of the completion
fundoplication is reduced to less than 0.5 cm to avoid problems of overcompetence. There were no operative deaths. Follow-up is 100% by clinical history, 82.4% by radiology, and 61.8% by manometry. Radiological follow-up showed no recurrence or reflux, although 1 patient had esophageal mucus retention. Thirty patients (88.2%) are eating normally without
dysphagia or spontaneous
pain. Two patients (5.9%) have mild
dysphagia, and 1 of them also has mild spontaneous
pain. One patient has major residual
dysphagia, which is being treated conservatively, and 1 has required colon interposition. Good-quality results have been achieved in 94% of patients now followed 5 to 10.7 years.