Thoracoscopic surgery is increasingly used in the treatment of severe esophageal motility disorders.
OBJECTIVE
To compare the treatment results of thoracoscopic and open subtotal esophageal resection with cervical esophagogastric anastomosis in patients with severe esophageal motility disorders.
MATERIAL AND METHODS
This is a single-center, non-randomized, comparative study. The inclusion criteria were the diagnosis of achalasia and grade IV cardiospasm with megaesophagus, high risk of aspiration, and severe dysphagia. The study included 25 patients, divided into two groups: thoracoscopic subtotal resection with esophagoplasty was performed in 13 patients (group 1) and open surgery in 12 (group 2). In addition, operation duration, the frequency of conversion, blood loss, ICU and hospital length of stay were studied. Complications were classified according to Clavien-Dindo.
RESULTS
Duration of the transchiatal surgery was significantly shorter compared with thoracoscopy (p=0.028) and thoracotomy (p=0.015). ICU length of stay in group 1 was twofold shorter than in group 2 (p=0.013). Hospital length of stay in group 1 was shorter than in group 2 (p=0.003). Less respiratory complications were recorded in group 1 (p=0.027); there were no significant differences for other complications (surgical site infection, arrhythmia, anastomotic leakage). There were no lethal outcomes in both groups.
CONCLUSIONS
Thoracoscopic surgery has several advantages in the treatment of severe esophageal motility disorders. Therefore, it should be included in the arsenal of modern esophageal surgery, although further high-quality studies are needed to confirm its benefits.