Advertisement

World Journal of Surgery

, Volume 39, Issue 7, pp 1634–1641 | Cite as

Esophagectomy for End-Stage Achalasia

  • Thomas J. Watson
Surgical Symposium Contribution

Abstract

Achalasia is a disease for which treatments are palliative in nature. Success of therapy is judged by a number of metrics, the most important being relief of symptoms, such as dysphagia and regurgitation. Patients often compensate for symptoms though a variety of dietary and lifestyle modifications, making symptomatic assessment of therapeutic outcome unreliable. Given this fact, and the progressive nature of the condition if left inadequately treated, patients not infrequently present with the disabling manifestations of end-stage disease for which esophagectomy is the best option. In appropriately selected patients, and when performed in experienced centers, esophagectomy with foregut reconstruction can be undertaken successfully with acceptable rates of morbidity and mortality, as well as a good long-term symptomatic outcome, in cases of end-stage achalasia.

Keywords

Achalasia Lower Esophageal Sphincter Heller Myotomy Esophageal Resection Pneumatic Dilation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The author would like to thank Dr. Boris Sepesi for providing the photographs used in Figs. 1 and 2.

References

  1. 1.
    Mayberry JF (2001) Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 11:235–248PubMedGoogle Scholar
  2. 2.
    Vaezi MF, Baker ME, Achkar E et al (2002) Timed barium oesophagram: better predictor of long-term success after pneumatic dilation in achalasia than symptom assessment. Gut 50:765–770PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Duranceau A, Liberman M, Martin J et al (2012) End-stage achalasia. Dis Esophagus 25:319–330PubMedCrossRefGoogle Scholar
  4. 4.
    Rawlings A, Soper NJ, Oelschlager B et al (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 1:18–26CrossRefGoogle Scholar
  5. 5.
    Kurian AA, Bhayani N, Sharata A et al (2013) Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia. JAMA 148:85–90CrossRefGoogle Scholar
  6. 6.
    Nau P, Rattner D (2014) Laparoscopic Heller myotomy as the gold standard for treatment of achalasia. J Gastrointest Surg 18:2201–2207PubMedCrossRefGoogle Scholar
  7. 7.
    Iqbal A, Tierney B, Haider M et al (2006) Laparoscopic re-operation for failed Heller myotomy. Dis Esophagus 19:193–199PubMedCrossRefGoogle Scholar
  8. 8.
    Bonatti H, Hinder RA, Klocker J et al (2005) Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg 190:874–878PubMedCrossRefGoogle Scholar
  9. 9.
    Malthaner R, Todd TR, Miller L, Ranson FG (1994) Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg 58:1343–1347PubMedCrossRefGoogle Scholar
  10. 10.
    Glatz SM, Richardson JD (2007) Esophagectomy for end stage achalasia. J Gastrointest Surg 11:1134–1137PubMedCrossRefGoogle Scholar
  11. 11.
    Orringer MB, Stirling MC (1989) Esophageal resection for achalasia: indications and results. Ann Thorac Surg 47:340–345PubMedCrossRefGoogle Scholar
  12. 12.
    Pinotti HW, Cecconello I, da Rocha JM, Zilberstein B (1991) Resection for achalasia of the esophagus. Hepatogastroenterology 38:470–473PubMedGoogle Scholar
  13. 13.
    Gockel I, Kneist W, Eckardt VF et al (2004) Subtotal esophageal resection in motility disorders of the esophagus. Dig Dis 22:396–401PubMedCrossRefGoogle Scholar
  14. 14.
    Loviscek M, Wright AS, Hinojosa MW et al (2013) Recurrent dysphagia after Heller myotomy: is esophagectomy always the answer? J Am Coll Surg 216:736–744PubMedCrossRefGoogle Scholar
  15. 15.
    Banki R, Mason RJ, DeMeester SR et al (2002) Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg 236:324–335 discussion 335–336PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Peyre CG, DeMeester SR, Rizzetto C et al (2007) Vagal-sparing esophagectomy: the ideal operation for intramucosal adenocarcinoma and Barrett with high-grade dysplasia. Ann Surg 246:665–674PubMedCrossRefGoogle Scholar
  17. 17.
    Peters JH, Kauer WKH, Crookes PF et al (1995) Esophageal resection with colon interposition for end-stage achalasia. Arch Surg 130:632–637PubMedCrossRefGoogle Scholar
  18. 18.
    Miller DL, Allen MS, Trastek VF et al (1995) Esophageal resection for recurrent achalasia. Ann Thorac Surg 60:922–926PubMedCrossRefGoogle Scholar
  19. 19.
    Banbury MK, Rice TW, Goldblum JR et al (1999) Esophagectomy with gastric reconstruction for achalasia. J Thorac Cardiovasc Surg 117:1077–1085PubMedCrossRefGoogle Scholar
  20. 20.
    Devaney EJ, Iannettoni MD, Orringer MB, Marshall B (2001) Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 72:854–858PubMedCrossRefGoogle Scholar
  21. 21.
    Hsu H-S, Wang C-Y, Hsieh C-C et al (2003) Short-segment colon interposition for end-stage achalasia. Ann Thorac Surg 76:1706–1710PubMedCrossRefGoogle Scholar
  22. 22.
    Molena D, Mungo B, Stem M, Feinberg RL, Lidor AO (2014) Outcomes of esophagectomy for esophageal achalasia in the United States. J Gastrointest Surg 18:310–317PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  1. 1.Division of Thoracic and Foregut Surgery, Department of SurgeryUniversity of Rochester Medical CenterRochesterUSA

Personalised recommendations