title: Surgical treatment analysis of idiopathic esophageal achalasia.
abstract: BACKGROUND
  Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia.
  
  
  OBJECTIVE
  To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications.
  
  
  METHODS
  Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease.
  
  
  RESULTS
  The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing.
  
  
  CONCLUSIONS
  The strategy proposed for the surgical treatment of idiopathic esophageal achalasia according to the stages of the disease was of great value, due to post-surgical low morbidity complications and proper recovery of swallowing.
authors.affiliation: Department of the Hospital and Maternity Celso Pierro, School of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
authors.forename: José Luis Braga de
authors.initials: JL
authors.lastname: Aquino
authors.affiliation: Department of the Hospital and Maternity Celso Pierro, School of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
authors.forename: Marcelo Manzano
authors.initials: MM
authors.lastname: Said
authors.affiliation: Department of the Hospital and Maternity Celso Pierro, School of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
authors.forename: Douglas Rizzanti
authors.initials: DR
authors.lastname: Pereira
authors.affiliation: Department of the Hospital and Maternity Celso Pierro, School of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
authors.forename: Paula Casals do
authors.initials: PC
authors.lastname: Amaral
authors.affiliation: Department of the Hospital and Maternity Celso Pierro, School of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
authors.forename: Juliana Carolina Alves
authors.initials: JC
authors.lastname: Lima
authors.affiliation: Department of the Hospital and Maternity Celso Pierro, School of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
authors.forename: Vânia Aparecida
authors.initials: VA
authors.lastname: Leandro-Merhi
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies