TEN YEAR EXPERIENCE IN SURGICAL TREATMENT OF ACHALASIA.

منتظری, وحید and سکوتی, محسن (2008) TEN YEAR EXPERIENCE IN SURGICAL TREATMENT OF ACHALASIA. J Urmia Univ Med Sci., 19 (1). pp. 61-66.

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Abstract

Achalasia is a well characterized esophageal motor disorder but the rarity of the disease limits performing large studies on its clinical features and also the results of the surgery. This study examined the results of Heller cardiomyotomy on achalasia and treatment of recurrence of achalasia and esophageal resection. Materials & Methods: From 1995 to 2005, 25 patients (16 women and 9 men)�underwent�initial surgical treatment for achalasia. Ages of the patients ranged from 15 to 70 (mean 35.2 years). They were treated previously with cardiomyotomy with or without antireflux procedures that had been done through standard left posterolateral thoracotomy. The etiology of symptoms recurrence was incomplete myotomy in three (12%), end staging megaesophgus in two (8%). The patients were studied by clinical (dysphasia, regurgitation, heartburn, and weight gain), radiological, and endoscopic evaluation, in the pre and postoperative periods. Results: Twenty one (84%) improved from dysphagia but Mild dysphasia maintained in four (16%). Peak contraction pressures (measured in 24% of patients) became significantly weaker: from 42 mmHg to19 mmHg in the distal esophagus. Weight gain maintained or increased in 84%.�Operative�complications were perforations occurred in four�patients�that were repaired primarily with antireflux procedures. In one case of megaesophagus perforation widened and reversed to laterolateral esophagogastric anastomosis with antireflux procedure. There was no complication in the late postoperative period. No deaths were observed. Conclusion: Initial cardiomyotomy with or without antireflux procedure via thoracic route has good and effective result in the treatment of the achalasia. In recurrence of symptoms and when myotomy is incomplete, when scars of fibrosis were present completed cardiomyotomy via abdominal route was preferred. In cases of mega esophagus surgical resection of esophagus is indicated.

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