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Oesophagectomy for end stage Achalasia

ABDULREHMAN ABDULJAMEEL

Abstract


Achalasia is the commonest primary esophageal
motility disorder, characterized
by the failure of lower oesophageal
sphincter (LOS) to relax along with loss
of peristalsis in the oesophageal body
and increased resting pressure of the
LOS. Patients present with long-standing
progressive dysphagia for both liquid and
solid ,other symptoms include regurgitation,
respiratory symptoms due to chronic
aspiration and weight loss due to nutritional
failure. End stage achalasia is
characterized by dialated and tortuous
sigmoid oesophagus in patients previously
treated with either pneumatic dilation
or myotomy and failure of further
such therapy to relieve symptoms. Oesophagectomy
for such cases can help
achieve good symptom control, improve
nutrition and enable a good quality of life.
We present a series of 3 cases of end
stage achalasia managed by transhaital
oesophagectomy and gastric pull up followed
by cervical oesophago-gastric anastomosis
and review the literature on
management of end stage achalasia.


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