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De Aquino et al. Mini-invasive Surg 2017;1:167-72 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.29
www.misjournal.net
Topic: Achalasia Management: the South American viewpoint Open Access

Non-conventional surgical approach

to achalasia: mucosectomy and

endomuscular pull-through

Jose Luis Braga De Aquino, Marcelo Manzano Said, José Gonzaga Teixeira De Camargo
Department of Surgery, Medical School, Catholic University at Campinas, Campinas, SP 13015-192, Brazil.

Correspondence to: Dr. Jose Luis Braga De Aquino, Department of Surgery, Medical School, Catholic University at Campinas, Boaventurado Amaral, 1190,
ap. 12-CEP, Campinas, SP 13015-192, Brazil. E-mail: jlaquino@sigmanet.com.br

How to cite this article: De Aquino JLB, Said MM, De Camargo JGT. Non-conventional surgical approach to achalasia: mucosectomy and endomuscular
pull-through. Mini-invasive Surg 2017;1:167-72.

ABSTRACT
Article history: Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage
Received: 27 Jul 2017 achalasia that avoids the complications of a thoracotomy. This technique; however, is still
First Decision: 10 Aug 2017 linked to some degree of morbimortality especially due to pleuromediastinal complications.
Revised: 1 Oct 2017 Esophageal mucosectomy and endomuscular pull-through could avoid these complications.
Accepted: 14 Oct 2017 This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and
Published: 28 Dec 2017 endomuscular pull-through in a series of patients with advanced megaesophagus. Methods:
We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal
Key words: mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished
Achalasia, most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short
esophagectomy, and long-term follow-up based on clinical, endoscopic and tomographic evaluation. Results:
megaesophagus, Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and
mucosectomy pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42
patients. Excellent and good clinical results were obtained in 83% of the patients. Conclusion:
Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the
treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at
long-term follow-up.

INTRODUCTION Different approaches have been proposed to
treat this disease, such as endoscopic dilatation,
Idiopathic and chagasic achalasia have different esophageal caliber-reducing operations, operations
etiology but, apart from this fact, both diseases on the diaphragm or esophageal extrinsic innervation,
share the same clinical, radiologic, endoscopic and cardiectomy, cardioplasties, transthoracic and
manometric presentations. Thus, any therapeutic transhiatal esophagectomy. Neither treatment;
modality may be applied equality irrespective of however, seems to be ideal since they do not act
etiology. directly on the physiopathology of the disease [1-5] .

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