Heller Cardiomyotomy in end stage of achalasia with mega esophagus: Results in five cases

Manouchehr Aghajanzadeh 1, Afshin Shafaghi 4, Omid Mosafaee Rad 1, Zahra Sadin 2, 3, Alireza Shirzadi 5 and Mohaya Farzin 6, *

1 Department of Thoracic and General Surgery, Guilan University of Medical Sciences, Rasht, Iran.
2 Aria Hospital, Guilan University of Medical Sciences, Rasht, Iran.
3 Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
4 Gastroenterologist Hepatologist, GI Cancer Screening and Prevention Research Center (GCSPRC), Guilan University of Medical Sciences, Rasht, Iran.
5 Department of Anesthesiology, Negah hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
6 Department of physiology, Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran.
 
Research Article
GSC Advanced Research and Reviews, 2024, 19(02), 072–081.
Article DOI: 10.30574/gscarr.2024.19.2.0159
 
Publication history: 
Received on 17 March 2024; revised on 29 April 2024; accepted on 01 May 2024
 
Abstract: 
Achalasia is a motility disorder of esophagus with poor emptying and, characterised by a lack of peristalsis and impaired relaxation of the lower esophageal sphincter with high LES pressure,diameter  of esophsgous  can increase, and some patients progress  to develop end-stage achalasia as megaesophagus or sigmoid esophagus and significant form  dilation and tortuosity.These omplications occurs in between 5% and 20% of patients with acha­lasia. This group of patients if untreated are at risk of aspiration, aspiration pneumonia, and malnutrition.
The management of this type of achalasia, aims to palliate symptoms by improving esophagus emptying and reducing the pressure gradient.  In this group of patients, pneumatic dilatation (PD), surgical myotomy, or peroral endoscopic myotomy (POEM) may be less or not effective.
Esophagectomy for the treatment of end-stage achalasia remains a controversial topic and has been recommended by some authors. We describe 5 patients with end-stage achalasia who was been successfully managed with laparotomy heller cardiomyotomy . In 4,12,18,24 months follow- up the condition of patients was good.
 
Keywords: 
Achalasia; Dysphagia; Esophageal motility; High-resolution manometry; Megaesophagus; Laparotomy heller cardiomyotomy; Esophagectomy
 
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Copyright information: 
Copyright © 2024 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0

 

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