Esophagectomy for End Stage Achalasia

Abstract

Esophageal myotomy is the standard primary therapy for achalasia. However, reports on long-term results of myotomy have suggested a deterioration of outcome over time with many patients presenting with end stage disease several years after esophagomyotomy. Eight patients who had previously undergone esophagomyotomy for achalasia presented with recurrent or worsening symptoms, and after preoperative evaluation, were treated by esophagectomy via laparotomy and right thoracotomy. The mean age at the time of myotomy was 52 years (range 18 to 62 years), and the mean time until esophagectomy was 12.5 years (range 2 to 18 years) after the initial myotomy. The median time until esophagectomy was performed after myotomy was 14 years. All patients in this series gained weight (mean, 23 pounds; range, 9 to 42 lbs) following esophagectomy, and none of the patients complained of dysphagia at follow-up or developed stricture. There were no major complications (including anastomotic leak) or deaths in this series. Five of the patients have been followed a mean of six years and remain well. Esophagectomy is a safe and appropriate treatment option in the setting of recurrent and end stage achalasia.

Recurrent achalasia treated with Heller myotomy: A review of the literature

“…Median hospital stay was 2.6-8 d. One study [32] has reported the efficacy of HM for achalasia patients who failed combined treatment with PD and BoTx. The remission rate was 83%, operation duration was 156 min, and the hospital stay was 3.5 d. There were five [33][34][35][36][37] studies and two [38,39] studies that assessed the efficacy of HM for failed HM as the first-line treatment. The remission rate was 73%-100%.…”

Avaliação da anastomose esofagogástrica cervical com sutura mecânica e manual em pacientes com megaesôfago avançado

“…E ntre as operações realizadas no tubo digestivo, as efetuadas no esôfago se revestem de especial interesse, devido à maior freqüência de complicações, notadamente referente às deiscências das anastomoses [1][2][3][4][5][6] . O advento da sutura mecânica, divulgada a partir da década de 60 por Ravitch & Steichen 7 , fez com que se desenvolvessem aparelhos caracterizados pela maior segurança e precisão, tentando assim, reduzir o risco de fístula anastomótica, além de simplificar a sua realização.…”

Achalasia—If Surgical Treatment Fails: Analysis of Remedial Surgery

“…The choice of the operative approach and the type of interposition are strongly determined by the type of previous surgery. Esophagectomyopen [62][63][64][65][66] or minimally invasive 32,67-69 -with gastric pull-up or colon interposition is the preferred procedure and can be performed with low morbidity, leading to symptomatic relief and restoration of alimentation and quality of life.…”