Chagas' disease affects about 5 to 8 million individuals in Brazil, with 5% to 8% of them developing megaesophagus.
Transformating of the esophagus into an inert tube renders is unable to propel food to the stomach.
In order to prevent complications, the elected treatment for advanced megaesophagus is subtotal esophagectomy.
Dr Crema evaluated the outcome of laparoscopic transhiatal subtotal esophagectomy in the treatment of advanced megaesophagus.
The team included 30 patients with advanced esophagopathy, 26 with chagasic and 4 with idiopathic megaesophagus.
The patients were submitted to transhiatal subtotal esophagectomy without thoracotomy through laparoscopy and left cervicotomy.
|1 patient developed anastomotic esophagogastric stenosis|
|Annals of Thoracic Surgery|
The investigative team performed contrast exams of the esophagus, stomach, duodenum, and upper digestive tract endoscopy.
The investigators also performed esophageal electromanometry, and 24-hour pHmetry during the preoperative and postoperative period.
With respect to the surgical technique, pyloroplasty was not performed.
The cervical esophagus was dissected through a left cervicotomy.
The team performed esophagogastric anastomosis between the cervical segment of the esophagus and the posterior wall of the stomach.
No death or conversion to open surgery occurred in the present series.
The investigators observed complications in 27%, pneumothorax in 20%, and cervical fistulas in 7%.
The team also noted that transient dysphonia occurred in 23%, and 1 patient had anastomotic esophagogastric stenosis.
Another 1 of the patients developed dysphagia for solid food after 36 months.
The team observed this despite normal the esophagus, stomach, duodenum,upper digestive tract endoscopy, electromanometry, and 24-hour pHmetry.
Dr Crema's team commented, “The present results show that laparoscopic transhiatal subtotal esophagectomy is a feasible and safe procedure with an excellent postoperative outcome.”