title: Esophagectomy with gastric reconstruction for achalasia.
abstract: OBJECTIVE
  Achalasia is a degenerative esophageal disorder that may result in esophageal failure necessitating resection for restoration of gastrointestinal function. This study evaluates a protocol of esophageal resection and gastric reconstruction for end-stage achalasia.
  
  
  METHODS
  Hospital records, radiographic studies, and resection specimens of patients undergoing esophagectomy and gastric reconstruction were reviewed. Patient outcome was defined by an evaluation of symptoms (early satiety, dysphagia, regurgitation, and reflux), dietary restrictions, and ability to maintain or gain weight. Preoperative, operative, and postoperative variables and pathologic features in the resection specimens were analyzed to determine predictors of outcome.
  
  
  RESULTS
  In a 10-year period, 32 patients underwent esophagectomy with gastric reconstruction for achalasia; 30 (94%) underwent elective surgery and 2 (6%), emergency surgery. No postoperative deaths occurred. Of 29 patients completing telephone interviews, 24 (83%) had no or mild dysphagia; 21 (72%), no or mild regurgitation; 20 (69%), no or mild reflux; and 19 (66%), no or mild early satiety. Twenty-four (83%) patients had no or minimal dietary restrictions; 26 (90%) had no or minimal social dietary restrictions. Postoperative weight was not different from preoperative weight. Of 30 patients, 26 (87%) felt better after esophagectomy and 25 (83%) would have the operation again. There were few predictors of outcome. Younger patients were more likely to have dysphagia ( P =.03).
  
  
  CONCLUSIONS
  Esophagectomy with gastric reconstruction relieves preoperative dysphasia and regurgitation in the majority of patients. Dietary function and weight maintenance are excellent, attesting to the durability of the procedure in patients with end-stage achalasia.
authors.affiliation: Center for Swallowing and Esophageal Disorders and the Departments of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Banbury
authors.forename: T W
authors.initials: TW
authors.lastname: Rice
authors.forename: J R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: S B
authors.initials: SB
authors.lastname: Clark
authors.forename: M E
authors.initials: ME
authors.lastname: Baker
authors.forename: J E
authors.initials: JE
authors.lastname: Richter
authors.forename: L A
authors.initials: LA
authors.lastname: Rybicki
authors.forename: E H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000294:innervation / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009197:Myenteric Plexus / Q000473:pathology; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome