Comparative evaluation of the effectiveness of laparothoracoscopic esophagectomy with intrapleural esophagogastroplasty and laparoscopic transhiatal resection of the esophagus with esophagogastroanastomosis and fundoplication in the terminal stage of cardia achalasia

Allakhverdyan A. S., Anipchenko A. N., Anipchenko N. N.

The traumatism and increased risk of complications of esophagectomy with simultaneous esophageal plasty, which is often performed in the treatment of end-stage achalasia of the cardia (AC), motivates the search for new solutions to this problem. We perform laparoscopic transhiatal resection of the S-shaped altered lower third of the esophagus. In the area of ​​the esophageal-gastric anastomosis, we form a fundoplication cuff with its fixation to the diaphragm to prevent recurrence of the S-shaped deformity of the esophagus. Purpose: comparative analysis of the effectiveness of laparothoracoscopic esophagectomy and laparoscopic transhiatal resection of the esophagus and fundoplication in the terminal stage of AK. Materials. Patients with AK V stage were divided into 2 groups: group 1 (n=10) - laparothoracoscopic esophagectomy with intrapleural esophagogastroplasty, group 2 (n=10) - laparoscopic transhiatal resection of the esophagus and fundoplication. Results. Surgical intervention in the first group is longer by 175 minutes than in the second (p=0.048). The volume of blood loss in the first group is 185 ml more than in the second group (p=0.002). Patients of the first group after the operation were in the ICU, on average, 18 (14; 19) hours, patients of the second group were transferred from the operating room immediately to the general ward. The duration of the postoperative stationary period in the first group was 9.5 (7; 13) bed-days, in the second - 9 (8; 9) bed-days (p=0.759). The duration of postoperative observation of patients of the first group was 39±9.4 months, the second - 35±3.6 months. In 40% of patients of the first group, the anastomosis zone is freely passable for contrast, the anastomosis is slightly narrowed, and the expanded part of the esophagus above the anastomosis was determined. In the second group, good results were observed in 100% of cases: the anastomosis area was freely passable for contrast, the anastomosis was not narrowed. Conclusion. Laparoscopic transhiatal resection of the esophagus with esophagogastroanastomosis and fundoplication showed good immediate and long-term results. This intervention can be considered the operation of choice in the terminal stage of AK.

Keywords:achalasia, esophagectomy, esophageal resection, fundoplication.