Page 167 - Read Online

Crema et al. Mini-invasive Surg 2017;1:160-6 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.26
www.misjournal.net
Topic: Achalasia Management: the South American viewpoint Open Access

Minimally invasive esophagectomy in achalasia:

a more liberal approach to esophageal resection

Eduardo Crema , Júverson Alves Terra Júnior , Guilherme Azevedo Terra , Celso Junior de Oliveira Teles , Alex
1
1
2
2
Augusto da Silva 1
1 Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG 38025-440, Brazil.
2 School of Medicine, Federal University of Triângulo Mineiro, Uberaba, MG 38025-440, Brazil.
Correspondence to: Dr. Eduardo Crema, Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG 38025-440, Brazil. E-mail:
cremauftm@mednet.com.br
How to cite this article: Crema E, Júnior JAT, Terra GA, de Oliveira Teles CJ, da Silva AA. Minimally invasive esophagectomy in achalasia: a more
liberal approach to esophageal resection. Mini-invasive Surg 2017;1:160-6.

ABSTRACT
Article history: Aim: The advent of minimally invasive abdominal and thoracic surgeries has led to a meaningful
Received: 12 Jul 2017 reduction in complication and mortality rates among patients undergoing esophagectomy,
First Decision: 1 Aug 2017 especially when used for the treatment of benign diseases such as megaesophagus. Methods:
Revised: 31 Aug 2017 Two hundred thirty-one patients, 152 (65.8%) men and 79 (34.2%) women, with a mean age of
Accepted: 28 Sep 2017 52.46 (19-80) years, were treated for advanced megaesophagus between September 1996 and
Published: 28 Dec 2017 October 2016. Two hundred ten patients (90.91%) had chagasic megaesophagus and 21 patients
(9.09%) had idiopathic megaesophagus. Results: Immediate complications were observed in 37
Key words: patients (16.01%): hemopneumothorax in 22 cases (9.52%), gastric stasis in 11 (4.76%), cervical
Advanced megaesophagus, fistula in 11 (4.76%), dysphonia in 18 (7.8%), and mediastinitis in 1 case (0.43%). Two patients
vagal preservation, (0.86%) died: 1 patient with a pacemaker died of cardiorespiratory arrest on postoperative day
transhiatal esophagectomy, 12 and the other patient died of mediastinitis on day 28. Our standardized protocol includes
laparoscopic esophagectomy nutritional and pulmonary outpatient care. Conclusion: With a standardized multidisciplinary
protocol and a team adequately trained in laparoscopy, minimally invasive esophagectomy
is an excellent option for the treatment of advanced megaesophagus. The technique is easily
standardized and reproducible, and provides excellent postoperative outcomes.

INTRODUCTION esophagectomy, especially when used for the treatment
of benign diseases such as megaesophagus .
[1]
The scientific rationale for choosing the best surgical
treatment for a condition is to offer patients a procedure Advanced megaesophagus mainly affects young male
that removes or abrogates the symptoms and adverse adults. It is a chronic progressive motor disorder of
risks of the condition, thus reducing the number of esophageal peristalsis that results in dilatation, tortuosity,
complications and the mortality rate. The advent of and elongation of the esophagus. Megaesophagus is
minimally invasive abdominal and thoracic surgeries commonly associated with pulmonary complications
has led to a meaningful reduction in complication due to acute or chronic bronchoaspiration, and
and mortality rates among patients undergoing with a higher frequency of epidermoid esophageal

Quick Response Code:
This is an open access article licensed under the terms of Creative Commons Attribution 4.0 International
License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution,
and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the
identical terms.
For reprints contact: service@oaepublish.com

160 © The Author(s) 2017 www.oaepublish.com