Jasso-Barranco R, Lozano-Corona R, Hernández-Hernández G, Jaramillo-García C

Language: Spanish
References: 28
Page: 108-111
PDF size: 42.15 Kb.

ABSTRACT

Background: Esophageal excision is recommended in advanced stages of achalasia, when the esophagus acquires a sigmoid morphology. This procedure reduce the risk of bronchoaspiration and development of neoplasms; a relation which has been observed in megaesophagus at rates ranging from 3.2 to 18.92%. Aim: demonstrate the feasibility of laparoscopic transhiatal esophagectomy in patients with advanced stage achalasia. Case report: Male 51 years old, with a history of hypertension, denied smoking, alcohol occasionally and surgical history of conventional Heller myotomy for 15 years and myotomy reoperation four years. He began his current condition six months prior to surgery with progressively dysphagia to solids and liquids with severe regurgitation, halitosis and loss of weight of 15 kg. Esophagogram in which image shows megaesophagus and sigmoid esophagus. Endoscopy reports with significant dilatation of the esophagus, sigmoid esophagus, esophagitis, and abundant food remains, stomach with superficial gastritis. Previously treated by pneumatic dilatation twice successfully, but without clinical improvement. Transhiatal esophagectomy was performed laparoscopically with gastric and cervical sphagogastroanastomosis with adequate postoperative course. Contrast study at five days postoperatively, is seen with adequate integrity of the anastomosis; diet starts without postoperative complications and discharge its decided at seventh postoperative day with supplementary feeding. Thirty days postoperatively meets adequate oral tolerance and recovery of 2 kg of body weight. Conclusion: Laparoscopic transhiatal esophagectomy is a treatment option for patients diagnosed with advanced staging of achalasia. Offering the benefits of minimally invasive surgery with good postoperative results.

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