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OESOPHAGECTOMY FOR ACHALASIA OF THE CARDIA - INDIAN
Kanagavel Manickavasagam1, Kannan Devy Gounder2, Visvarath Varadarajan*3, Apsara Chandramohan4, Chandramohan Servarayan Murugesan5
1Dept of General, GI and Minimal Access Surgery, St Isabel Hospital, Chennai, India; 2Department of Surgical Gastroenterology, Saveetha Medical College, Chennai, India; 3Sri Ramachandra Medical College, Chennai, Tamilnadu, India; 4Govt Kilpauk Medical College, Chennai, Tamilnadu, India; 5Department of Surgical Gastroenterology, St Isabel Hospital, Chennai, Tamilnadu, India
Introduction
In the era of per oral endoscopic myotomy, advancement in manometry and laparoscopy the treatment for achalasia cardia is well defined. Oesophagectomy has only a limited role in rare patients with sigmoid esophagus, perforation during nonsurgical treatment and malignancy. This study is about the indications of esophagectomy for achalasia cardia from one of the high volume centers for upper gastrointestinal disorders in India
Methods
This study includes 10 patients (7 male, 3 female) between august 2010 to august 2016.They had symptoms like dyspnea, dysphagia, regurgitation, chest discomfort, weight loss and cough. The duration of symptoms range from 2-120 months. Seven patients underwent previous pneumatic dilatation, four underwent Laproscopic Hellers cardiomyotomy with fundoplication (dor 3,toupet 1) and one patient had both pneumatic dilatation and cardiomyotomy.The indications for esophagectomy were sigmoid esophagus, failed pneumatic dilatation and laproscopic hellers cardiomyotomy,perforation after pneumatic dilatation and malignancy. The procedures done were transhiatal esophagectomy with stomach pull-up in 8 patients, Transthoracic esophagectomy in one, Esophagogastrectomy with transabdominal intrathoracic esophagojejunal anastomosis in one patient.. The follow-up range between 2-72 months. During follow-up one patient developed hepatocellular carcinoma right lobe and died.
Conclusion
In the era where nonresection treatment play a major role in the management of achalasia cardia, esophagectomy still has a role in select patients. The indications for esophagectomy in our series included failed endotherapy, failed Hellerscadiomyotomy,sigmoid esophagus and malignancy
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