Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Pochini, Celso de Castro; Gagliardi, Danilo; Júnior, Roberto Saad; Almeida, Ruy França de; Corsi, Paulo Roberto

doi:10.1590/0100-69912015005006

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…Patients should be closely followed af ter the operation based on the elevated risk for metaplasia, dysplasia and even carcinoma transformation in the esophageal stump [27][28][29] . Some authors opt for chronic use of proton pump inhibitors after esophagectomy to prevent acid esophagitis in the stump [27] .…”

Section: Discussionmentioning

confidence: 99%

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Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Aquino¹,

Said²,

Camargo³

2017

MIS

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Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications. This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus. Methods: We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation. Results: Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients. Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up. Key words:Achalasia, esophagectomy, megaesophagus, mucosectomy ABSTRACTArticle history:

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Section: Discussionmentioning

confidence: 99%

“…Some authors opt for chronic use of proton pump inhibitors after esophagectomy to prevent acid esophagitis in the stump [27] .…”

Section: Discussionmentioning

confidence: 99%

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Aquino¹,

Said²,

Camargo³

2017

MIS

View full text Add to dashboard Cite

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“…Although this complication was of low incidence, it needs to be considered due to the possibility of this compromised epithelium evolve to adenocarcinoma, as has already been demonstrated 17 , 27 . Hence, it is important to carry out a long-term follow-up with periodic digestive endoscopies, as recommended in these two patients in our study, or even the prolonged use of proton pump inhibitors to minimize reflux and its complications 24 , 27 .…”

Section: Discussionmentioning

confidence: 63%

“…Another fact to be remembered is that one patient from each group evolved in the late postoperative period with Barrett’s esophagus in the esophageal stump. This change is usually a consequence of acid reflux and bile of the stomach transposed due to stasis, as has been demonstrated by some authors 24 , 26 , 27 . Although this complication was of low incidence, it needs to be considered due to the possibility of this compromised epithelium evolve to adenocarcinoma, as has already been demonstrated 17 , 27 .…”

Section: Discussionmentioning

confidence: 75%

Comparative Analysis of Late Results of Cervical Esophagogastric Anastomosis by Manual and Mechanical Suture in Patients Submitted to Esophageal Mucosectomy Through Advanced Megaesophagus

Aquino

Leandro‐Merhi

Mendonça

et al. 2019

ABCD, arq. bras. cir. dig.

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Background:Among the anastomoses of the gastrointestinal tract, those of the esophagus are of special interest due to several anatomical or even general peculiarities. Aim:Evaluate retrospectively the results comparing mechanical vs. manual suture at cervical esophagogastric anastomosis in megaesophagus treatment. Methods:Were included 92 patients diagnosed with advanced megaesophagus with clinical conditions to undergo the surgery. All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. In order to make this anastomosis, the patients were divided into two groups: group A (n=53) with circular mechanical suture, lateral end; group B (n=39) with manual suture in two sides, lateral end. In the postoperative period, an early evaluation was performed, analyzing local and systemic complications and late (average 5.6 y) analyzing deglutition. Results:Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%) in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6 (15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the patients presented the criteria 4 and 5 from SAEED, expressing effective swallowing mechanisms without showing significant differences among the groups. Conclusion:Cervical esophagogastric anastomosis by means of mechanical suture is more proper than the manual with lower incidence of local complications and, in the long-term evaluation, regular deglutition was acquired in both suture techniques in equal quality.

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“…As for the surgical time, the open operation was faster and the shortest time was 120 min (mean 170); in the laparoscopy it was 180 min (mean of 227). There was one death in each group related to gastric stasis due to the lack of pyloroplasty 23 , 26 . The fistula index (26%) found no difference between EMIL and ETHA and was similar to the literature (10-26%) 11 , 28 ; was lower in laparoscopy (20%), but without statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Laparoscopic Esophagectomy vs. Transhiatal Open Esophagectomy in Achalasia: A Randomized Study

Fontan

Batista-Neto

Pontes

et al. 2018

ABCD, arq. bras. cir. dig.

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Background:Open and laparoscopic trans-hiatal esophagectomy has been successfully performed in the treatment of megaesophagus. However, there are no randomized studies to differentiate them in their results. Aim:To compare the results of minimally invasive laparoscopic esophagectomy (EMIL) vs. open trans-hiatal esophagectomy (ETHA) in advanced megaesophagus. Method:A total of 30 patients were randomized, 15 of them in each group - EMIL and ETHA. The studied variables were dysphagia score before and after the operation at 24-months follow-up; pain score in the immediate postoperative period and at hospital discharge; complications of the procedure, comparing each group. Were also studied: surgical time in minutes, transfusion of blood products, length of hospital stay, mortality and follow-up time. Results:ETHA group comprised eight men and seven women; in the EMIL group, four women and 11 men. The median age in the ETHA group was 47.2 (29-68) years, and in the EMIL group of 44.13 (20-67) years. Mean follow-up time was 33 months, with one death in each group, both by fatal aspiration. There was no statistically significant difference between the EMIL vs. ETHA scores for dysphagia, pain and in-hospital complications. The same was true for surgical time, transfusion of blood products and hospital stay. Conclusion:There was no difference between EMIL and ETHA in all the studied variables, thus allowing them to be considered equivalent.

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Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Cited by 5 publications

References 29 publications

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Comparative Analysis of Late Results of Cervical Esophagogastric Anastomosis by Manual and Mechanical Suture in Patients Submitted to Esophageal Mucosectomy Through Advanced Megaesophagus

Minimally Invasive Laparoscopic Esophagectomy vs. Transhiatal Open Esophagectomy in Achalasia: A Randomized Study

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