Surgical Treatment of Achalasia Cardia: Outcomes of a Differentiated Approach

Introduction: This article describes the application of a stage-based surgical approach in patients with achalasia cardia treated in the surgical department of the Amur Regional Clinical Hospital. In all cases, the diagnosis was confirmed by esophageal radiography and esophagoscopy.
Material and methods: All patients were women aged 42 to 74 years, with a mean disease duration of 10.3±8.5 years. Disease staging was performed according to B.V. Petrovsky’s classification. A patient with Stage III achalasia underwent video-laparoscopic esophagocardiomyotomy combined with esophagocardiogastroplasty (modified by T.A. Suvorova). For Stage IV achalasia, laparotomy with resection of the abdominal esophagus and circular stapled esophagogastric anastomosis was performed. In a case of Stage IV recurrent achalasia following Heller myotomy, laparotomy and esophagogastric anastomosis were carried out.
Results: Follow-up radiographic (with contrast) and endoscopic examinations in the early and late postoperative periods (6–12 months) demonstrated favorable short- and long-term outcomes.
Conclusion: Surgical strategy for achalasia cardia should be guided by disease stage. Laparoscopic myotomy with esophagocardiogastroplasty is optimal for Stage III. In contrast, esophagogastric anastomosis combined with esophageal resection is preferred for Stage IV and recurrent disease.

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