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Crema et al. Minimally invasive esophagectomy in achalasia

parasympathetic autonomic nervous system occurs 4. Wang D, Zhang R, Sun K. The digestive functions of the stomach after
in this condition (digestive tract myenteric and esophagectomy with vagus nerve preserved or severed in esophageal
submucosal plexuses). It is known that the chronically cancer patients: a comparative study. Zhonghua Zhong Liu Za Zhi
2000;22:414-6. (in Chinese)
denervated stomach develops intrinsic mechanisms 5. Eduardo C, Madureira AB, Lima VG, Castro AM, Silva AA, Junqueira
that maintain motility and emptying. In patients with IS. Microflora in chagasic megaesophagus. Rev Soc Bras Med Trop
idiopathic megaesophagus undergoing vagotomy, 2002;35:39-42. (in Portuguese)
impairment of gastric emptying is observed during 6. Crema E, De Lima TS, Junqueira IS, Rodrigues Junior V, Terra Júnior
the first months after surgery. Previous studies have JA, Silva AA. Prevalence study of esophageal HPV infection in
shown better gastric emptying after esophagectomy patients with megaesophagus and correlation with in situ and 24-hour
PH measurement. Bras J Video-Sur 2010;3:181-5.
even in patients with chagasic megaesophagus and 7. Fonseca FM, Queiroz DM, Rocha AM, Prata A, Crema E, Rodrigues
vagal nerve preservation. Junior V, Ramirez LE, Oliveira AG. Seroprevalence of Helicobacter
pylori infection in chagasic and nonchagasic patients from the same
With a standardized multidisciplinary protocol and a geographical region of Brazil. Rev Soc Bras Med Trop 2012;45:194-8.
team adequately trained in laparoscopy, minimally 8. DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E.
invasive esophagectomy is an excellent option for the Laparoscopic transhiatal esophagectomy with esophagogastroplasty.
Surg Laparosc Endosc 1995;5:1-5.
treatment of advanced megaesophagus. The technique 9. Crema E, Ribeiro LB, Terra JA Jr, Silva AA. Laparoscopic transhiatal
is easily standardized and reproducible, and provides subtotal esophagectomy for the treatment of advanced megaesophagus.
excellent postoperative outcomes. Ann Thorac Surg 2005;80:1196-201.
10. Crema E, Ribeiro LB, Sousa RC, Terra Júnior JA, Silva BF, Silva AA,
DECLARATIONS Silva AV. Laparoscopic transhiatal esophagectomy for the treatment
of advanced megaesophagus. An analysis of 60 cases. Rev Col Bras
Cir 2009;36:118-22. (in Portuguese)
Authors’ contributions 11. Crema E, Cruvinel LA, Werneck AM, de Oliveira RM, Silva AA.
Surgical procedures: E. Crema, J.A.T. Júnior, A.A. da Manometric and radiologic aspects of Chagas' megaesophagus:
Silva the importance to its surgical treatment. Rev Soc Bras Med Trop
Monitoring of patients: G.A. Terra, C.J. de Oliveira 2003;36:665-9. (in Portuguese)
Teles 12. Molena D, Mungo B, Stem M, Lidor AO. Hospitalization for
esophageal achalasia in the United States. World J Gastrointest
Endosc 2015;7:1096-102.
Financial support and sponsorship 13. Loviscek MF, Wright AS, Hinojosa MW, Petersen R, Pajitnov D,
None. Oelschlager BK, Pellegrini CA. Recurrent dysphagia after Heller
myotomy: is esophagectomy always the answer? J Am Coll Surg
2013;216:736-43; discussion 743-4.
Conflicts of interest 14. Orringer MB, Stirling MC. Esophageal resection for achalasia:
There are no conflicts of interest. indications and results. Ann Thorac Surg 1989;47:340-5.
15. Devaney EJ, Lannettoni MD, Orringer MB, Marshall B.
Patient consent Esophagectomy for achalasia: patient selection and clinical
experience. Ann Thorac Surg 2001;72:854-8.
All patients were guided by the surgical technique and 16. Rodgers M, Jobe BA, O'Rourke RW, Sheppard B, Diggs B, Hunter JG.
the risks inherent in the procedure. Case volume as a predictor of inpatient mortality after esophagectomy.
Arch Surg 2007;142:829-39.
Ethics approval 17. Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S,
The procedure was approved by the Human Research Way LW. Laparoscopic Heller myotomy and Dor fundoplication for
achalasia: analysis of successes and failures. Arch Surg 2001;136:870-7.
Ethics Committee of the Federal University of Triângulo 18. Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henríquez
Mineiro. A. Very late results of esophagomyotomy for patients with achalasia:
clinical, endoscopic, histologic, manometric, and acid reflux studies
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