Surgical treatment analysis of idiopathic esophageal achalasia

Abstract

BackgroundIdiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia.AimTo demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications.MethodsWere studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease.ResultsThe patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing.ConclusionThe strategy proposed for the surgical treatment of idiopathic esophageal achalasia according to the stages of the disease was of great value, due to post-surgical low morbidity complications and proper recovery of swallowing.

Realização de cardiomiotomia a heller-pinotti em paciente com megaesôfago grau ii: Relato de acalásia idiopática / Heller-pinotti cardiomyotomy in a patient with grade ii megaesophagus: Report of idiopathic acalasia

“…Existem comprovações de anormalidades no sistema nervoso intrínseco e extrínseco do esôfago, as quais vão se tornando cada vez mais graves a medida em que a doença avança, assim tornando-se mais visíveis as alterações no corpo do esôfago, em decorrência a um infiltrado inflamatório no plexo de Auerbach, levando a transformação de células saudáveis como as intramurais por tecido fibroso. (AQUINO et al, 2015).…”

Análise Comparativa Epidemiológica da Cirurgia de Esofagectomia Realizada por Via Transtorácica e por Via Minimamente Invasiva

“…Diferente do megaesôfago chagásico, que tem um agente causal bem definido, a acalasia do esôfago é um quadro idiopático caracterizado pela redução ou pela ausência completa da peristalse do corpo do esôfago. Além disso, há falha do mecanismo fisiológico de relaxamento do esfíncter esofágico inferior durante a deglutição, o que desencadeia a principal manifestação clínica: a disfagia 4 . É o distúrbio de motilidade esofágica mais comum, apresentando uma incidência de 1 a cada 100.000 pessoas por ano 5 .…”

Late Evaluation of Dysphagia After Heller Esophageal Myotomy With Dor Fundoplication for Achalasia

“…Esophageal achalasia is an uncommon motility disorder of the esophagus, with an incidence of between 0.03 to 1 per 100,000 individuals 5 with no preference in terms of age or gender 14 . This condition can be classified as idiopathic, chagasic, pseudoachalasia or linked to syndromic contexts 2 , 19 . It is secondary to an irreversible degeneration of Auerbach’s myenteric plexus of the esophagus, causing aperistalsis and the absence of lower esophageal sphincter relaxation 9 , 10 , 13 , 18 , 22 , 23 .…”