Esophageal resection for recurrent achalasia

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Background:

• Achalasia, a rare esophageal motility disorder, often requires surgical intervention.
• Recurrence or complications following initial achalasia treatment may necessitate further surgical management.
• Esophageal resection is a potential, albeit significant, surgical option for complex achalasia cases.

Purpose of the Study:

• To evaluate the efficacy and outcomes of esophageal resection in patients with achalasia recurrence or treatment complications.
• To analyze the morbidity and mortality associated with esophageal resection for achalasia.
• To assess long-term functional results after esophageal resection in this patient cohort.

Main Methods:

• A retrospective analysis of 37 patients who underwent esophageal resection between 1976 and 1992 for achalasia-related issues.
• Patients had prior treatments including Heller myotomy or antireflux procedures.
• Reconstruction involved gastric, colonic, or small bowel conduits with cervical or intrathoracic anastomosis.

Main Results:

• Two operative deaths (5.4%) occurred, both related to hemorrhage during transhiatal resection.
• Complications affected 32.4% of patients, including anastomotic leaks, cardiac dysrhythmias, and pulmonary issues.
• Despite complications, 91.4% of patients achieved excellent or good long-term functional results.

Conclusions:

• Esophageal resection can yield satisfactory long-term functional outcomes for patients with complicated achalasia.
• Transhiatal resection, specifically, demonstrated a higher rate of morbidity and mortality in this series.
• Careful patient selection and surgical approach are crucial when considering esophageal resection for achalasia.