Modified Heller´s Esophageal Myotomy Associated with Dor’s Fundoplication A Surgical Alternative for the Treatment of Dolico Megaesophagus_ Crimson Publishers

  Modified Heller´s Esophageal Myotomy Associated with Dor’s Fundoplication A Surgical Alternative for the Treatment of Dolico Megaesophagus by AV Madureira F* in Gastroenterology Medicine & Research_ Gastroenterology Medicine & Research

 

Abstract

The most performed surgery for the treatment of achalasia is Heller´s esophageal myotomy associated or no with anti-reflux fundoplication. We propose in cases of advanced megaesophagus, specifically in the dolico megaesophagus, a technical variation. The aim of this study was to describe Heller´s myotomy modified by Madureira associated with Dor´s fundoplication as an alternative for the treatment of dolico megaesophagus, assessing its effectiveness at through dysphagia scores and quality of life questionnaires.

Materials and methods: Technical Note describing the surgical procedure and presenting the results of three patients with advanced dolico megaesophagus, operated from 2014 to 2017. The technique proposes the dissection of the esophagus intrathoracic, with circumferential release of it, in the most extensive possible by trans hiatal route. Then the esophagus is retracted and fixed circumferentially in the pillars of the diaphragm with six or seven point. The goal is at least on the third part of the esophagus, to achieve its broad mobilization and rectification of it; then is added a traditional Heller myotomy.

Results: The mean dysphagia score in pre-op was 10points and in the post- op was 1.3 points (maximum of 10 points being observed each between the pre and postoperative 8.67 points, 86.7%) The mean hospitalization time was one day. There was no surgical mortality or conversion to open technique. The mean follow-up time was 30.6 months (24-38 months) (Table 1). Heller’s Cardio myotomy modified by Madureira, associated with Dor’s fundoplication is an option to be investigated for the treatment of the dolico megaesophagus.

Keywords: Megaesophagus; Esophageal myotomy; Heller’s myotomy; Dor’s fundoplication; Dysphagia

Summary
Esophageal achalasia is a rare pathology in the population incidence between 0.03 and 1per 100,000 individuals [1]. It doesn’t have age or gender preference. It’s the most common esophageal motility disorder diagnosed [2]. According to his etiology, it can be classified into idiopathic, chagasic, pseudo achalasia. Trimanoma cruzi infection, in the countries of South America (and Brazil), has a relevant impact and is known that about 5% of patients affected by Chagas disease, they turn on achalasia [3] and that the dilation of the esophagus appears to be greater in the chagasic etiology [4]. The pathophysiology of the disease is seen hypertension in the Lower Esophageal Sphincter (LES) and an inability to drive the esophageal content, for aperistalsis or uncoordinated peristaltic movements. Histologically there is destruction or decrease of the mioenteric plexus cells. The condition usually has insidious onset, and its main symptom is dysphagia. Patients are shown to have poor quality of life, are emaciate and are also limited to their work activities. The most commonly used test for diagnosis is the esophageal manometry that evaluates the motility of the esophagus and lower esophageal sphincter pressure (LESP)

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