European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2005
Comparative pre- and postoperative results analysis of functional state of the esophagus assessment in patients with various stages of achalasia.
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Onopriev Vladimir Ivanovich, Durleshter Vladimir Moiseevich, Ryabchun Vadim Valerevich
Аннотация
OBJECTIVE: The aim of this study was to evaluate main results of morpho-functional state of the esophagus assessment in patients with various stages of achalasia before and after surgical treatment.
METHODS: Between 1993 and 2002, a total of 65 patients with achalasia (26 males, 39 females; mean age 44.5+/-14.0 years; range 16-79) underwent specific type of surgical treatment based on the results of functional state of the esophagus assessment. Barium swallow, manometry and 24-h pH-metry were performed by standard methods; the main parameters of each study were evaluated before and after operation. Patients were divided into three groups according to the esophageal diameter (barium swallow examination data). Group I (n = 22, diameter < 4 cm), group II (n = 35, diameter from 4 to 7 cm), group III (n = 8, diameter > 7 cm, with the cardiac stenosis and S-shape deformation of the distal esophagus). All the patients in groups I and II underwent esophagocardiomyotomy with the creation of dilating antireflux cardia by Onopriev (fundoplication + esophageal ligament apparatus reconstruction). Five patients in group III with the cardiac stenosis underwent resection of the cardia with segmental esophagocardioplasty, three patients with the cardiac stenosis and sigmoid esophagus underwent resection of the stenosed cardia, extirpation of the esophageal muco-submucosal layer with subsequent replacement of it with the left colon placed in saved muscular sheath of the esophagus.
RESULTS: There were no deaths or reoperations. The study showed that a decrease of both maximal and residual LES pressures after operation in group I (from 24.3+/-3.8 to 21.7+/-2.4 and from 17.2+/-2.4 to 11.8+/-1.4, respectively) and group II (from 29.6+/-2.6 to 21.7+/-2.4 and from 21.7+/-3.1 to 11.8+/-1.4, respectively) of patients with achalasia enables to eliminate obstruction and therefore to decrease esophageal diameter.
CONCLUSIONS: We suggest that dilating antireflux cardia provides adequate bolus passage and properly realizes antireflux barrier function, maintaining the esophageal distal pH within the physiological ranges even without esophageal peristalsis restoration, and dilating mechanism serve to prevent the recurrence of the disease. Despite excellent relief of dysphagia and functional state of the esophagus improvement, the main values of functional state assessment results in group III of patients were beyond physiological ranges.
METHODS: Between 1993 and 2002, a total of 65 patients with achalasia (26 males, 39 females; mean age 44.5+/-14.0 years; range 16-79) underwent specific type of surgical treatment based on the results of functional state of the esophagus assessment. Barium swallow, manometry and 24-h pH-metry were performed by standard methods; the main parameters of each study were evaluated before and after operation. Patients were divided into three groups according to the esophageal diameter (barium swallow examination data). Group I (n = 22, diameter < 4 cm), group II (n = 35, diameter from 4 to 7 cm), group III (n = 8, diameter > 7 cm, with the cardiac stenosis and S-shape deformation of the distal esophagus). All the patients in groups I and II underwent esophagocardiomyotomy with the creation of dilating antireflux cardia by Onopriev (fundoplication + esophageal ligament apparatus reconstruction). Five patients in group III with the cardiac stenosis underwent resection of the cardia with segmental esophagocardioplasty, three patients with the cardiac stenosis and sigmoid esophagus underwent resection of the stenosed cardia, extirpation of the esophageal muco-submucosal layer with subsequent replacement of it with the left colon placed in saved muscular sheath of the esophagus.
RESULTS: There were no deaths or reoperations. The study showed that a decrease of both maximal and residual LES pressures after operation in group I (from 24.3+/-3.8 to 21.7+/-2.4 and from 17.2+/-2.4 to 11.8+/-1.4, respectively) and group II (from 29.6+/-2.6 to 21.7+/-2.4 and from 21.7+/-3.1 to 11.8+/-1.4, respectively) of patients with achalasia enables to eliminate obstruction and therefore to decrease esophageal diameter.
CONCLUSIONS: We suggest that dilating antireflux cardia provides adequate bolus passage and properly realizes antireflux barrier function, maintaining the esophageal distal pH within the physiological ranges even without esophageal peristalsis restoration, and dilating mechanism serve to prevent the recurrence of the disease. Despite excellent relief of dysphagia and functional state of the esophagus improvement, the main values of functional state assessment results in group III of patients were beyond physiological ranges.