Author:
Luis Braga de Aquino José,Aparecida Leandro-Merhi Vânia
Abstract
Of the several procedures that has to treat esophageal achalasia, the esophagectomy is to be the most indicated in advanced disease, which prompted Pinotti the disseminate the transmediastinal esophagectomy technique in the 1970s, with the advantage of avoiding thoracotomy. Nevertheless, several series demonstrated that this technique was not exempt from complications one of which could lead to massive hemopneumothorax due to injury to the trachea- bronchial tree and vessels due the periesophagitis that may be present with consequent adherence of the esophagus to these noble organs. Thus, Aquino in 1996 introduced the esophageal mucosectomy technique with preservation of the esophageal muscle tunic at the level of mediastinum as well as the transposition of the stomach to the cervical region inside in this tunic for the reconstruction of digestive tract. The advantage of this procedure is to avoid transgression of the mediastinum. This author describes in details this procedure, and shows early results and late evaluation using the ECKARDT score in a series of patients showing the advantages of the esophageal mucosectomy due the low incidence of immediate postoperative complications and good resolution in long term due the absence of symptoms in most patients.
Reference68 articles.
1. Aquino JLB, Said MM, Camargo JGT. Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through. Mini-invasive Surg. 2017;1:167-172
2. Zaninotto G, Bennet C, Boeckxstaens G, Costatini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31(9):1-29. DOI: 10.1093/dote/doy071. PMID: 30169645
3. Vaezi MF, Pandolfino JE, Yadiapati RH, Greer KB, Kavit RT. ACG Clinical Guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020;115:1393-1411
4. Jung HK, Hong SJ, Lee OY, Pandolfino JE, Park H, MiwaH, et al. 2019 Seoul Consensus on Esophageal Achalasia Guidelines. J Neurogastroenterol Motil. 2020;26(2):180-203
5. Rezende JM. Historia da cirurgia da acalasia do esôfago e do megaesôfago chagásico. 4ª ed. Goiânia: Editora Kelps; 2011 [citado 20 nov. 2017]. Disponível em: http://www.jmrezende.com.br/acalasia.htm. Portuguese