title: Laparoscopic esophagogastrostomy: an alternative minimally invasive treatment for achalasia stage III.
abstract: BACKGROUND
  The surgical treatment for stage III achalasia with markedly dilated and sigmoid-shaped esophagus is a matter of controversy. Some authors recommend esophagectomy as the primary treatment because they believe that Heller myotomy cannot improve dysphagia in such cases. We present a patient with achalasia stage III in whom we successfully performed a laparoscopic esophagogastrostomy with posterior semifundoplication.
  
  
  METHODS
  Using a five-trocar technique, the esophagogastric junction and the distal esophagus up to the tracheal bifurcation were dissected. An endoscopic stapler (Endo-GIA II) was inserted through a small gastrotomy at the cardia, with one branch placed in the gastric fundus and the other, under esophagoscopic control, in the esophagus. By two consecutive stapler applications, a wide side-to-side esophagogastrostomy was created. To prevent gastroesophageal reflux, a posterior semifundoplication was performed.
  
  
  RESULTS
  The operation time was 170 min. Oral food intake was started after radiologic control on postoperative day 7. Radiologic study showed rapid passage of the barium meal and no reflux through the gastroesophageal junction.
  
  
  CONCLUSIONS
  Laparoscopic esophagogastrostomy with posterior semifundoplication represents an alternative to esophagectomy and laparoscopic Heller-Dor surgery. Because of the wide side-to-side anastomoses, there is no risk of persisting stenosis such as that reported for the Heller operation, and the procedure certainly is less invasive than esophagectomy. As compared with laparoscopic extramucosal myotomy using anterior Dor fundoplication, it presents about the same technical difficulties.
authors.affiliation: Department of General, Visceral, Vascular, and Thoracic Surgery, Charité, Humboldt University Berlin, Schumannstrasse 20/21, D-10117 Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Ablassmaier
authors.forename: C A
authors.initials: CA
authors.lastname: Jacobi
authors.forename: R
authors.initials: R
authors.lastname: Stoesslein
authors.forename: I
authors.initials: I
authors.lastname: Opitz
authors.forename: J M
authors.initials: JM
authors.lastname: Müller
mesh_terms: D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004931:Esophageal Achalasia / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009543:Nifedipine / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D009543:Nifedipine