ObjectivesMucosal stripping vagal sparing esophagectomy removes the esophageal mucosa while preserving the esophageal muscular wall. This procedure is an option in patients with end-stage achalasia and megaesophagus, and avoids a thoracotomy as well as the risk of significant bleeding that can occur with a transhiatal resection in these patients. The aim of this study is to assess the in hospital characteristics and long term outcome of patients who underwent mucosal stripping vagal sparing esophagectomy.MethodsRetrospective review of the charts and symptomatic follow-up of all patients who had mucosal stripping vagal sparing esophagectomy for end stage achalasia from 1993-2008. ResultsThere were 19 patients (7 males/12 females) with a median age of 49 years. Previous myotomy was performed in 10/19 (53%) and previous dilatation in 16/19 (84%). Gastric pull-up was performed in 10 (53%) and colonic interposition in 9 (47%). There were no perioperative deaths. The median operative blood loss was 800 ml and the median hospital stay was 13 days. No patient had mediastinal bleeding requiring thoracotomy. Perioperative complications included: mediastinal fluid collection in 4 and an abscess between the native esophageal muscle and the gastric pull-up in 1. Four patients required reoperation including: evacuation of mediastinal hematoma in 1, VATS for multiloculated pleural effusion in 1, chronic colonic ischemia requiring take down of conduit in 1 and repair of anastomotic breakdown in 1 patient. At a median follow-up of 6 years, 18/19 (95%) patients were alive. Six patients (32%) had nocturnal regurgitation but none required reoperation (4 colon interposition and 2 gastric pull-up). On symptomatic follow-up 16/19 (84%) were free of dumping and 16/19 (84%) were free of diarrhea. The median weight loss was 7 pounds in 10/19 (53%) patients and the weight returned to the preoperative value in 9/19 (47%). ConclusionsMucosal stripping vagal sparing esophagectomy can be performed safely in patients with end-stage achalasia and megaesophagus with minimal mediastinal bleeding. Placement of the graft within the native esophageal muscular tube minimizes redundancy and displacement of the graft. Regurgitation is more significant after colon interposition, and gastric pull-up is now favored. Mucosal stripping vagal sparing esophagectomy should be considered in the surgical treatment of patients with end stage achalasia and megaesophagus.