Advances in the Surgical Management of Achalasia Cardia: A Review | Chapter 9 | Medical Science: Updates and Prospects Vol. 2

 

Achalasia cardia, an oesophageal dynamic disorder, is a relatively rare primary motor oesophageal disease characterised by the functional loss of plexus ganglion cells in the distal oesophagus and lower oesophageal sphincter. The management of Achalasia Cardia can be divided into medical and surgical management. This chapter synthesises the literature findings to examine the various surgical procedures available for achalasia cardia, focusing on their respective advantages and potential complications. The surgical management of achalasia cardia has undergone significant advancements over the past decade, particularly following the introduction of Heller's myotomy. Currently, laparoscopic Heller's myotomy, often accompanied by partial fundoplication, is regarded as the gold standard for the surgical treatment of achalasia cardia. Additionally, robotic Heller's myotomy is gradually gaining prominence with the advent of robotic surgical techniques. In contrast, thoracoscopic myotomy is now infrequently performed, and esophagectomy is reserved for patients with end-stage achalasia cardia. The choice of surgical approach is typically individualised, taking into account the patient’s condition and risk profile.

 

Author(s) Details
Kumar H.R.
Taylor’s University School of Medicine Clinical Campus,4700 Sg Buloh, Selangor, Malaysia.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v2/6625

Mucosectomy and Endomuscular Pull-Through: Non-Conventional Surgical Approach to Achalasia | Chapter 14 | Advancement and New Understanding in Medical Science Vol. 6

Aim: Esophageal achalasia is characterized by incomplete relaxation of the lower esophageal sphincter and absence of peristalsis along the esophageal body with a consequence dilatation of the organ. Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications. This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus.
 
Methods: We retrospectively studied 115 patients with end-stage achalasia who underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the gastric pull-up into the muscular tunnel. Forty-two patients were followed for more than 10 years. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation.
 
Results: A complete removal of the mucosa was observed in all 115 patients. Anastomotic leak or stenosis was present in 27%. Pleural effusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients.
 
Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up.

Author(s) Details:

Jose Luis Braga De Aquino,
Department of Surgery, Medical School, Catholic University at Campinas, Campinas, SP 13015-192, Brazil.

Marcelo Manzano Said,
Department of Surgery, Medical School, Catholic University at Campinas, Campinas, SP 13015-192, Brazil.

José Gonzaga Teixeira De Camargo,
Department of Surgery, Medical School, Catholic University at Campinas, Campinas, SP 13015-192, Brazil.

Please see the link here: https://stm.bookpi.org/ANUMS-V6/article/view/13365