Page 176 - Read Online

De Aquino et al. Esophageal mucosectomy in advanced achalasia

Table 1: Clinical evaluation
Satisfaction
Weight Return to
Swallowing status Regurgitation Bowel movements with the Grade
variation work
procedure
Normal Absent Unchanged Gain 2
Occasional dysphagia Ocasional Diarrhea/constipation occasional Unchanged Yes Yes 1
Frequent dysphagia Frequent Diarrhea/constipation frequent Loss No No 0
The sum of these grades was defined as a global clinical evaluation and classified as: 10 and 9 - excellent; 8 and 7 - good; 6 and 5 -
regular; < 4 - bad

Table 2: Computerized tomography evaluation - Table 3: Computerized tomography evaluation -
retrosternal transposition of the graft intraesophageal transposition of the graft
Medestinal Compression Medestinal esophageal Grade Medestinal Displasce-
fluid of the graft muscular layer Medestinal Compression esophageal ment of Grade
Absence Absence Observed 1 fluid of the graft muscular the graft
Present Present Not observed 0 layer
Absence Absence Observed Absence 1
The sum of these grades was defined as a global clinical evaluation Present Present Not observed Present 0
and classified as 3 - excellent; 2 - good; 1- regular; 0 - bad
The sum of these grades was defined as a global clinical evaluation
Short-term follow-up and classified as 4 and 3 - excellent; 2 - good; 1- regular; 0 - bad
Patients were kept in the intensive care unit (ICU) for discharged from the ICU during the first 48 h. Oral diet
24-48 h after the operation. Early feeding through the was started between the 7th-10th postoperative days
jejunostomy was started as soon as bowel motility in 82 (72%) patients after the esophagram attested
returned and progressed to 2,500 to 3,000 calories/ absence of leaks. Jejunostomy tube was removed
day according to standard pathways by dedicated after 3-4 weeks after the operation when a solid diet
nutritionists. was possible. Oral feeding was postponed in 31 (27%)
patients due to anastomotic leakage and reintroduced
Oral feeding was introduced after anastomotic integrity between days 18-29 after the esophagram attested
was confirmed through an esophagram between absence of leaks.
the 7th and 10th postoperative day. This routine was
changed; however, in the event of clinical suspicious Radiologic evaluation
of anastomotic leak when the test was repeated or Chest X-Ray was unremarkable in 92 (80%)
done in variable periods. Chest X-Ray was performed patients. In the remaining patients, discrete to mild
routinely in all patients 24 h after the operation and pleural effusion was noticed in 13 (11%) patients
every 72 h during the first week or in case of necessity. and pulmonary infiltrate in 10 (9%) patients. Barium
esophagram was performed in 86 (76%) patients with
Long-term follow-up unremarkable findings in 82 of them. Anastomotic
Forty-two patients were followed for more than leak was detected in 4 patients. All patients had the
10 years. Variables used to assess outcomes are test repeated between 18-26th postoperative day to
[9]
depicted in Tables 1-4 . show absence of leak and strictures.

RESULTS Complications
Mortality was 2%. Two patients died due to sepsis
after graft necrosis in the 3rd postoperative day
Short-term results and other due to pulmonary embolism in the 5th
Pathologic examination of the specimen postoperative day. A tube thoracostomy was
A complete removal of the mucosa was observed necessary in 9 out of 13 (11%) patients with pleural
in all 115 patients. Microscopic examination showed effusions and moderate volume. Only observation
mild to severe inflammation of the mucosa and was enough in the 4 remaining. Pneumonia was
submucosa. Leukoplakia was found in 18 (15.7%) diagnosed and treated in 10 (9%) patients with
cases. Carcinoma was not observed. satisfactory outcomes. Anastomotic leak in 31 (27%)
patients was managed conservatively with resolution
Clinical evaluation in all cases. In 22 cases, however, an anastomotic
One hundred thirteen (98%) patients out of the 115 stenosis was present and treated satisfactorily in all
total had an uneventful recovery and they were patients with endoscopic dilatation.

Mini-invasive Surgery ¦ Volume 1 ¦ December 28, 2017 169