title: Subtotal esophageal resection in motility disorders of the esophagus.
abstract: BACKGROUND
  Esophagectomy for motility disorders is performed infrequently. It is indicated after failed medical therapy, pneumatic dilation, non-resecting surgical and redo procedures. Patient selection in this group is challenging and the operative risk has to be weighted carefully against the poor quality of life with persistent or recurrent dysphagia.
  
  
  METHODS
  Between September 1985 and April 2004, subtotal esophageal resections for advanced esophageal motility disorders of the esophagus not responding to previous therapy were carried out in 8 patients (6 females, 2 males). The median age of these patients was 59.5 (43-78) years. Six patients had a megaesophagus secondary to achalasia; 1 patient had a non-specific esophageal motility disorder with a stenosis of the distal esophagus, and a further patient displayed a recurrent huge epiphrenic diverticulum, which occurred in the context of a collagen disease. A transhiatal esophageal resection was performed in 6, a transthoracic procedure in 2 patients.
  
  
  RESULTS
  Outcome assessment was done after a follow-up of 43.5 (3-92) months in median. The resection and reconstruction of the esophagus in advanced and decompensated esophageal motility disorders led to a marked functional improvement with disappearance of dysphagia. Despite previous therapeutic failures, alimentation could be restored in all patients.
  
  
  CONCLUSIONS
  Favourable long-term results with significant improvement of symptoms can be achieved by esophageal resection even if endoscopic therapy or non-resecting surgical measures are unsuccessful. Transhiatal esophagectomy with gastric pull-up should be the preferred procedure and can be performed with low morbidity.
authors.affiliation: Department of General and Abdominal Surgery, Johannes Gutenberg University, Mainz, Germany. gockel@ach.klinik.uni-mainz.de
authors.forename: Ines
authors.initials: I
authors.lastname: Gockel
authors.forename: Werner
authors.initials: W
authors.lastname: Kneist
authors.forename: Volker F
authors.initials: VF
authors.lastname: Eckardt
authors.forename: Katja
authors.initials: K
authors.lastname: Oberholzer
authors.forename: Theodor
authors.initials: T
authors.lastname: Junginger
mesh_terms: D000328:Adult; D000368:Aged; D015154:Esophageal Motility Disorders / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome