OBJECTIVE

Evaluation of the effectiveness of video endoscopic operations in «advanced» forms (stages 3—4) and recurrence of cardia achalasia (AC).

MATERIAL AND METHODS

In 2003—2018, 320 patients with AC were treated in our clinic (63.1% of women, 36.9% of men). 55.5% of patients (176/320) were diagnosed with stage 3—4 AC. Resections/extirpations of the esophagus with simultaneous esophagoplasty were performed in 55 (17.1%) patients with «advanced» forms or recurrence of AC. Since 2013, resections/extirpations of the esophagus for AC have been performed by laparoscopic or combined laparothoracoscopic approaches (47.3% of patients). Laparoscopic transchiatal extirpation of the esophagus with simultaneous esophagogastroplasty was performed in 9 patients. According to our original method, 5 patients underwent resection of the lower thoracic esophagus by laparoscopic transchiatal access. Subtotal resection of the esophagus by combined laparoscopic and thoracoscopic access on the right (Lewis type) was performed in 10 patients. In 2 cases, laparoscopic and thoracoscopic accesses on the right were supplemented with cervical.

RESULTS

Laparoscopic esophagocardiomyotomy proved effective in 91.2% of cases of stage 3—4 AC: analysis of long-term treatment results showed that there is a restoration of esophageal peristalsis and a significant narrowing of its lumen even in the presence of pronounced S-shaped expansion before surgery. After esophageal plastic surgery, complications developed in 7 (12.7%) patients.

CONCLUSION

In advanced forms of AC, cardiodilation in 100% of cases leads to a recurrence of dysphagia with a high risk of pulmonary complications. Laparoscopic esophagocardiomyotomy during mobilization of the lower thoracic esophagus with its descent into the abdominal cavity, extended myotomy, the formation of an incomplete extended fundoplication cuff is associated with a fairly low number of recurrence of dysphagia, including in patients with «neglected» forms of AC. With a high risk of aspiration pneumonia, stage 4 AC, relapse after organ-sparing surgery and/or cardiodilation, the method of choice is video endoscopic extirpation / resection of the esophagus with simultaneous esophagoplasty.