title: Laparoscopic transhiatal esophagectomy for 'sigmoid' megaesophagus following failed cardiomyotomy: experience of 11 patients.
abstract: BACKGROUND
  Laparoscopic myotomy is a widely used procedure and is now considered to be the treatment of choice for achalasia. Esophagectomy for achalasia is usually performed only for megaesophagus. We present our experiences with laparoscopic transhiatal esophagectomy for 'sigmoid' megaesophagus due to failed Heller's myotomy.
  
  
  METHODS
  We managed a total of 11 patients with megaesophagus in our institute from 1993 to 2007. Work-up included investigations included endoscopy, barium swallow, and manometry. Laparoscopic transhiatal esophagectomy with gastric pull through was successfully performed for all cases.
  
  
  RESULTS
  The mean operating time was 317.5 min, and the mean blood requirement was 525 ml. The mean duration between the first and second procedures was 13 months. Our overall failure rate for primary surgery (myotomy) was 3.1% and overall symptomatic improvement was achieved in 82% of patients. There were no conversions.
  
  
  CONCLUSIONS
  About 10% of postmyotomy patients will have recurrence, and 5% of them need reoperation. Laparoscopic esophagectomy for sigmoid esophagus is a formidable operation due to adhesions/fibrosis at the hiatal area. Dissection of the S-shaped esophagus in the thorax is quite tedious and an accurate knowledge of the shape and location of the megaesophagus preoperatively is vital. If performed in specialized centers, laparoscopic excision is safe and effective, utilizing all the benefits of minimal access.
authors.affiliation: GEM Hospital & Postgraduate Institute, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore 641045, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.forename: Priyadarshan Anand
authors.initials: PA
authors.lastname: Jategaonkar
authors.forename: Gobi Shanmugam
authors.initials: GS
authors.lastname: Maheshkumaar
authors.forename: Natesan
authors.initials: N
authors.lastname: Vijay Anand
mesh_terms: D004931:Esophageal Achalasia / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008365:Manometry; D012008:Recurrence; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome