Hernández A, Vásquez A, García S, Tolosa M, Borjas P

Language: Spanish
References: 9
Page: 39-43
PDF size: 202.21 Kb.

ABSTRACT

Introduction: The esophageal achalasia is a primary motor disorder characterized by an abnormal motility of the upper part of the esophagus and also by a lack of easing on the lower esophageal sphincter as a response to the swallowing.
Case presentation: Male of 1 year and 6 months of age with severe malnutrition. Body mass index (BMI) of 1.4 with late of the psychomotor development, with vague symptoms of esophageal reflux; weight at revenue of 5 kg, double contrast upper-GI series for study of Gastroesophageal Reflux Disease (GERD), with presence of esophageal expansion in third distal. We proceed with the placement of a trocar of 5 mm in umbilical scar, one of 5 mm to subxifoid level for hepatic separation and two more of 5 mm to level of flanks as ports of work. There is proceeded to fulfil the miotomy of the region of the sphincter approximately 3 cm of the intra-abdominal esophagus, the funduplication realizes type Thal and procedure concludes.
Discussion: The best treatment is the surgery. The laparoscopic boarding must be used of routine because it allows an easy access to the low third of the esophagus, it allows to realize some anti reflux procedure, avoids the need to install a pleurostomy, diminishes the postoperatory pain and the complications of respiratory type that could be produced, favors the early discharge and therefore a rapid reintegration to the life habitual.
We have fulfilled in our patient a previous gastropexy type Thal that improves the procedure, it creates an angle of His acutely, the intra gastric pressure is transmitted directly to the low portion of the esophagus which has fewer transoperatory complications, and less percentage of fault.

REFERENCES

1. Trías M, Targarona EM, Viciano M, Cherichetti C, Sáinz S, Rius X, Monés J, Balanzó J. Tratamiento quirúrgico de la acalasia: estudio comparativo entre la cirugía abierta y la laparoscópica. Cirugía Española 2001; 70(6).

2. Covarrubias HMA, López CJA, Guzmán CF, Eduardo, Jaramillo TJ, Solórzano EA, Barrera ZLM. Cardiomiotomía de Heller con abordaje laparoscópico: Experiencia del HGR No. 1, IMSS, Tijuana; AMCE 8(1): 30-34.

3. Patti MG, Arcerito M, De Pinto M et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg 1998; 6: 561-566.

4. Karnak ME, Sëenocak FC, Tanyel N. Büyükpamukcëu, achalasia in childhood: surgical treatment and outcome. Eur J Pediatr Surg 2001; 11.

5. Rothenberg ST, Partrick DA, Bealer JF, Chang JHT. Evaluation of minimally invasive approaches to achalasia in children. journal of pediatric surgery 2001; 36(5): 808-810.

6. Esposito C, Mendoza-Sagaon M, Roblot-Maigret B et al. Complications of laparoscopic treatment of esophageal achalasia in children. J Pediatr Surg 2000; 35: 680-683.

7. Vaezi MF, Richter JE. Current therapies for achalasia: Comparison and efficacy. J Clin Gastroenterol 1998; 27: 21-35.

8. Patti MG, Albanese CT, George W, Holcomb III, Molena D, Fisichella PM. Laparoscopic Heller myotomy and dor fundoplication for esophageal achalasia in children. Journal of Pediatric Surgery 2001; 36(8): 1248-1251.

9. Patti MG, Feo CV, Arcerito M et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci 1999; 44: 2270-2276.