Aguirre RR, Castañeda CP, Valladares MA, Díaz RF, Pérez A

Language: Spanish
References: 38
Page: 29-34
PDF size: 152.99 Kb.

ABSTRACT

Objective: To evaluate the efficacy and safety of surgical treatment of achalasia by means of laparoscopy.
Setting: Second level health care hospitals, institutional and private.
Design: Prospective, longitudinal, observational study.
Patients and methods: From June 1994 to June 1998, 10 patients with diagnosis of achalasia were studied. There were six women and four men, average age of 40 years, all subjected to surgical treatment by laparoscopic approach. Heller-type esophagocardiomyotomy was performed in all patients aided by transoperative esophageal endoscopy. Criteria to perform or not an antireflux procedure were: caliber and functional capacity of the esophagus. Resolution of the esophageal obstruction was assessed clinically, radiologically, and endoscopically. Follow up was maintained for 1 to 4 years.
Results: The etiology of the achalasia was idiopathic in 9 patients and due to Chaga’s disease in one. All were subjected to esophagocardiomyotomy of 6 cm in length, with separations of esophageal borders in 40% of the esophageal circumference, guided and corroborated by transoperative esophageal endoscopy. Antireflux procedure was performed in 8 patients. Average surgical time was of 100 min, the esophageal mucosa was accidentally punctured in one patient and had to be converted to open surgery, suturing the perforation with separated stitches, the patient presented no complications. One patient presented minimal left pleural effusion that resolved spontaneously. No deaths occurred. Average hospital stay was 4 days. Dysphagia resolution was excellent in 90% and good in 10% of the patients, persisting during the 1-4 years follow-up.
Conclusion: Surgical treatment of achalasia by means of laparoscopy is a safe and efficient method to resolve functional obstruction of the distal esophagus at short- and mid-term, offering the advantages of minimally invasive surgery.

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