Laparoscopic esophagogastroplasty: a minimally invasive alternative to esophagectomy in the surgical management of megaesophagus with axis deviation
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The results of cardiomyotomy in patients of achalasic megaesophagus with axis deviation are not satisfactory, and several authors have advocated an esophagectomy in these patients. We describe the technical details and outcomes of a novel technique of laparoscopic esophagogastroplasty for end-stage achalasia.
Patients with end-stage achalasia, characterized by tortuous megaesophagus were selected. The surgery was performed in supine position using five abdominal ports. The steps included mobilization of the gastroesophageal junction and lower intrathoracic esophagus, straightening and anchoring the pulled intrathoracic esophagus into the abdomen, and a side-side esophagogastroplasty.
Four patients with megaesophagus due to end-stage achalasia underwent this procedure. The average duration of surgery was 177.5 (range, 120–240) min. All patients could be ambulated on the first postoperative day. Oral feeding was initiated by the third postoperative day, and all patients had significant improvements in their dysphagia scores. All patients had excellent cosmetic results and were discharged by the fifth postoperative day. An upper gastrointestinal contrast study done at 6 weeks after surgery did not show any hold up of contrast, and there was decrease in the convolutions and diameter of the esophagus. At a mean follow-up of 10.5 (range, 3–15) months, all patients are euphagic without significant symptoms of gastroesophageal reflux.
Laparoscopic esophagogastroplasty is an effective option for relieving dysphagia in megaesophagus due to achalasia with axis deviation and is a reasonable alternative before subjecting to a major and potentially morbid esophagectomy.
- Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249(1):45–57 CrossRef
- Goldblum JR, Rice TW, Richter JE (1996) Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 111(3):648–654 CrossRef
- Woltman TA, Pellegrini CA, Oelschlager BK (2005) Achalasia. Surg Clin North Am 85(3):483–493 CrossRef
- Vaezi MF, Richter JE (1999) Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol 94(12):3406–3412 CrossRef
- Devaney EJ, Lannettoni MD, Orringer MB, Marshall B (2001) Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 72(3):854–858 CrossRef
- Palanivelu C, Rangarajan M, Jategaonkar PA, Maheshkumaar GS, Vijay Anand N (2008) Laparoscopic transhiatal esophagectomy for ‘sigmoid’ megaesophagus following failed cardiomyotomy: experience of 11 patients. Dig Dis Sci 53(6):1513–1518 CrossRef
- Gockel I, Kneist W, Eckardt VF, Oberholzer K, Junginger T (2004) Subtotal esophageal resection in motility disorders of the esophagus. Dig Dis 22(4):396–401 CrossRef
- Pechlivanides G, Chrysos E, Athanasakis E, Tsiaoussis J, Vassilakis JS, Xynos E (2001) Laparoscopic Heller cardiomyotomy and Dor fundoplication for esophageal achalasia: possible factors predicting outcome. Arch Surg 136(11):1240–1243 CrossRef
- Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD, Society of American Gastrointestinal and Endoscopic Surgeons (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26(2):296–311 CrossRef
- Hsu HS, Wang CY, Hsieh CC, Huang MH (2003) Short-segment colon interposition for end-stage achalasia. Ann Thorac Surg 76(5):1706–1710 CrossRef
- Banki F, Mason RJ, DeMeester SR, Hagen JA, Balaji NS, Crookes PF, Bremner CG, Peters JH, DeMeester TR (2002) Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg 236(3):324–335 discussion 335-336 CrossRef
- Laparoscopic esophagogastroplasty: a minimally invasive alternative to esophagectomy in the surgical management of megaesophagus with axis deviation
Volume 27, Issue 6 , pp 2238-2242
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Quality of life
- Industry Sectors