MODIFIED ENDOVIDEOSURGICAL METHOD FOR THE TREATMENT OF ACHALASIA OF THE CARDIA

Abstract

Objective: to improve the results of surgical treatment of patients with achalasia of the cardia (AC) by improving some stages of Heller's operation using modern laparoscopic technologies.
The results of treatment of achalasia of the cardia of 35 patients are presented, men were 16, women – 19. The age ranged from 18 to 69 years, mean age was 49±5.4. The duration of the disease ranged from 1 year to 9 years. 28 (80%) patients had a body mass index (BMI) below 18.7 kg/m², mean BMI was 20.7±3.1 kg/m2. There were 26 (74.3%) with stage III disease, 7 (20%) with stage II and 2 (5.7%) with stage IV. The diagnosis was confirmed on the basis of fluoroscopy, endoscopy. Patients underwent extramucosal anterior extended esophagocardiomyotomy according to Heller with esophagocardiogastroplasty in modification of our clinic. Long-term results were traced in 24 (68,5%) patients in the period from 6 months to 5 years. Intraoperative complication in the form of esophageal mucosa perforation was in 2 (5,9%) patients, the defect was sutured. There were no fatal cases. The average score of Eckardt scale before surgery was 9.2±2.1, before discharge 1.7±0.2, and ≥6 months after surgery 1.3±0.4. No recurrence of the disease was noted. The advantages of this
method are efficiency, low risk of complications, possibility to eliminate the occurred complications during the operation, prevention of reflux esophagitis and Barrett's esophagus development.