A dissertation of ten surgical conditions

Ten patients with achalasia of the oesophagus were managed by the thoracic unit of Muhimbili Medical Centre between June, 1986 and March 1990. Four of these patients were managed while the author was attached to the unit. There were four males and six females (M:F = 2:3). Their ages ranged between 17 and 59 years with a mean of 34.8 years. Six of the patients had symptoms for less than three years at the time of initial presentation. Dysphagia, regurgitation and loss of weight were the commonest presenting symptoms. All the patients were managed by the modified Heller's myotomy, seven of them through thoracic and the remaining three through the abdominal approach. Apart from a few complications, the results of the operatiosns were satisfactory. Four mucosal perforations were noted, one occurring in a patient treated by the thoracic approach and the other three in the abdominal approach group. One patient was suspected to have an oesophageal stricture at follow-up but this was ruled out by oesophagoscopy. None had reflux or recurrence of symptoms and there was no operative death. post-operative hospital stay ranged between 10 and 17 days, mean 13.2 days. The patients were followed up for between 12 and 59 months (mean 27.5 months).