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Surgical treatment analysis of idiopathic esophageal achalasia
BACKGROUND: Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. AIM: To demonstrate the results of surgical therapy in th...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Colégio Brasileiro de Cirurgia Digestiva
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737328/ https://www.ncbi.nlm.nih.gov/pubmed/26176243 http://dx.doi.org/10.1590/S0102-67202015000200003 |
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author | de AQUINO, José Luis Braga SAID, Marcelo Manzano PEREIRA, Douglas Rizzanti do AMARAL, Paula Casals LIMA, Juliana Carolina Alves LEANDRO-MERHI, Vânia Aparecida |
author_facet | de AQUINO, José Luis Braga SAID, Marcelo Manzano PEREIRA, Douglas Rizzanti do AMARAL, Paula Casals LIMA, Juliana Carolina Alves LEANDRO-MERHI, Vânia Aparecida |
author_sort | de AQUINO, José Luis Braga |
collection | PubMed |
description | BACKGROUND: Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. AIM: To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications. METHODS: Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease. RESULTS: The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing. CONCLUSION: The strategy proposed for the surgical treatment of idiopathic esophageal achalasia according to the stages of the disease was of great value, due to post-surgical low morbidity complications and proper recovery of swallowing. |
format | Online Article Text |
id | pubmed-4737328 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Colégio Brasileiro de Cirurgia Digestiva |
record_format | MEDLINE/PubMed |
spelling | pubmed-47373282016-02-24 Surgical treatment analysis of idiopathic esophageal achalasia de AQUINO, José Luis Braga SAID, Marcelo Manzano PEREIRA, Douglas Rizzanti do AMARAL, Paula Casals LIMA, Juliana Carolina Alves LEANDRO-MERHI, Vânia Aparecida Arq Bras Cir Dig Original Article BACKGROUND: Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. AIM: To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications. METHODS: Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease. RESULTS: The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing. CONCLUSION: The strategy proposed for the surgical treatment of idiopathic esophageal achalasia according to the stages of the disease was of great value, due to post-surgical low morbidity complications and proper recovery of swallowing. Colégio Brasileiro de Cirurgia Digestiva 2015 /pmc/articles/PMC4737328/ /pubmed/26176243 http://dx.doi.org/10.1590/S0102-67202015000200003 Text en http://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article de AQUINO, José Luis Braga SAID, Marcelo Manzano PEREIRA, Douglas Rizzanti do AMARAL, Paula Casals LIMA, Juliana Carolina Alves LEANDRO-MERHI, Vânia Aparecida Surgical treatment analysis of idiopathic esophageal achalasia |
title | Surgical treatment analysis of idiopathic esophageal
achalasia |
title_full | Surgical treatment analysis of idiopathic esophageal
achalasia |
title_fullStr | Surgical treatment analysis of idiopathic esophageal
achalasia |
title_full_unstemmed | Surgical treatment analysis of idiopathic esophageal
achalasia |
title_short | Surgical treatment analysis of idiopathic esophageal
achalasia |
title_sort | surgical treatment analysis of idiopathic esophageal
achalasia |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737328/ https://www.ncbi.nlm.nih.gov/pubmed/26176243 http://dx.doi.org/10.1590/S0102-67202015000200003 |
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