Modern videolaparoscopic technology in the treatment of stage IV esophageal achalasia

Abstract

To evaluate the results of the use of videolaparoscopic technology in the treatment of esophageal achalasia. A clinical observation of a 47-year-old patient with stage IV esophageal achalasia (according to B.V. Petrovsky) is presented. There were complaints of dysphagia, regurgitation of food eaten, weight loss up to 10 kg. Anamnesis - for 9 years, the disease is associated with stress. Contrast fluoroscopy of the esophagus: the esophagus is expanded in the middle and lower thirds up to 7 cm, the distal esophagus is narrowed, S-shaped curved. Evacuation of contrast into the stomach - after 30 minutes. Esophagoscopy: the lumen of the esophagus in the middle and lower third is expanded, the mucosa is moderately hyperemic, hardly passable for the endoscope. The operation was performed: videolaparoscopic myotomy (according to Geller) with gastroplasty according to T.A. Suvorova. Unlike other types of gastroplasty, mobilization in the area of the abdominal esophagus and cardia is gentle and less injurious to the ligamentous apparatus. The anterior wall of the stomach in the form of a triangular fold is fixed with separate sutures to the edges of the defect formed after myotomy, and not only closes the defect, but also acts as a spacer, preventing the formation of restenosis. The displacement of the distal part of the esophagus under the diaphragm forms a more acute angle of His. The above features of the operation reduce the likelihood of reflux esophagitis. Early and late postoperative period is without complications. Dysphagia and regurgitation are absent. Contrast fluoroscopy of the esophagus after 1 year: free flow of contrast from the esophagus to the stomach. Esophagoscopy after 1 year: the esophagus is freely passable for the endoscope throughout its entire length. This clinical observation showed the effectiveness of using modern video-laparoscopic technology in the form of myotomy with gastroplasty according to T.A. Suvorova for stage IV esophageal achalasia, which was confirmed by the results of the early and late postoperative period.