Laparoscopic esophagogastroplasty: a minimally invasive alternative to esophagectomy in the surgical management of megaesophagus with axis deviation.

INTRODUCTION: The results of cardiomyotomy in patients of achalasic megaesophagus with axis deviation are not satisfactory, and several authors have advocated an esophagectomy in these patients. We describe the technical details and outcomes of a novel technique of laparoscopic esophagogastroplasty for end-stage achalasia.
METHODS: Patients with end-stage achalasia, characterized by tortuous megaesophagus were selected. The surgery was performed in supine position using five abdominal ports. The steps included mobilization of the gastroesophageal junction and lower intrathoracic esophagus, straightening and anchoring the pulled intrathoracic esophagus into the abdomen, and a side-side esophagogastroplasty.
RESULTS: Four patients with megaesophagus due to end-stage achalasia underwent this procedure. The average duration of surgery was 177.5 (range, 120-240) min. All patients could be ambulated on the first postoperative day. Oral feeding was initiated by the third postoperative day, and all patients had significant improvements in their dysphagia scores. All patients had excellent cosmetic results and were discharged by the fifth postoperative day. An upper gastrointestinal contrast study done at 6 weeks after surgery did not show any hold up of contrast, and there was decrease in the convolutions and diameter of the esophagus. At a mean follow-up of 10.5 (range, 3-15) months, all patients are euphagic without significant symptoms of gastroesophageal reflux.
CONCLUSIONS: Laparoscopic esophagogastroplasty is an effective option for relieving dysphagia in megaesophagus due to achalasia with axis deviation and is a reasonable alternative before subjecting to a major and potentially morbid esophagectomy.