title: EARLY AND LATE ASSESSMENT OF ESOPHAGOCARDIOPLASTY IN THE SURGICAL TREATMENT OF ADVANCED RECURRENT MEGAESOPHAGUS.
abstract: BACKGROUND
  Since Chagas disease has esophageal manifestations with different degrees of involvement, the best surgical option is controversial, especially for patients with advanced chagasic megaesophagus and recurrent symptoms after previous treatment.
  
  
  OBJECTIVE
  To assess the early and late outcomes of esophagocardioplasty in a series of patients with advanced recurrent chagasic megaesophagus.
  
  
  METHODS
  This descriptive study included 19 older patients with recurrent megaesophagus grade III/IV and positive immunofluorescence for Chagas disease. They had undergone cardiomyotomy with anterior fundoplication a mean of 16.5 years ago. Serra-Doria esophagocardioplasty was selected to treat the recurrence. The patients were followed to assess postoperative and late complications and the incidence of symptom recurrence.
  
  
  RESULTS
  In early assessment, five (26.3%) patients presented clinical complications. One (5.2%) patient had a gastrointestinal fistula secondary to esophagogastric anastomotic leak, which responded well to conservative treatment. In the one-year follow-up, 18 (94.7%) patients could swallow normally and had no vomiting. Three years after surgery, 10 (62.5%) of 16 patients could swallow normally, and 3 (19.3%) patients complained of vomiting. Five years after surgery, only 5 (38.4%) of 13 patients could swallow normally and 7 (53.8%) had vomiting.
  
  
  CONCLUSIONS
  Serra-Doria esophagocardioplasty for the treatment of advanced recurrent megaesophagus had mild postoperative complications and good success rate in the short-term follow-up. In the long-term follow-up, it proved to be a poor surgery choice because of the high incidence of symptom recurrence, compromising quality of life. This procedure should be indicated only for patients with advanced recurrent megaesophagus without clinical conditions to undergo esophageal resection.
authors.affiliation: Clínica Cirúrgica, Faculdade de Medicina, PUC-Campinas, SP, Brasil.
authors.forename: José Luis Braga de
authors.initials: JL
authors.lastname: Aquino
authors.affiliation: Clínica Cirúrgica, Faculdade de Medicina, PUC-Campinas, SP, Brasil.
authors.forename: Marcelo Manzano
authors.initials: MM
authors.lastname: Said
authors.affiliation: Clínica Cirúrgica, Faculdade de Medicina, PUC-Campinas, SP, Brasil.
authors.forename: Douglas Alexandre Rizzanti
authors.initials: DA
authors.lastname: Pereira
authors.affiliation: Faculdade de Nutrição, PUC-Campinas, SP, Brasil.
authors.forename: Vânia Aparecida
authors.initials: VA
authors.lastname: Leandro-Merhi
authors.affiliation: Serviço de Cirurgia, Hospital e Maternidade Celso Pierro, PUC-Campinas, SP, Brasil.
authors.forename: Paula Casals do
authors.initials: PC
authors.lastname: Nascimento
authors.affiliation: Serviço de Cirurgia, Hospital e Maternidade Celso Pierro, PUC-Campinas, SP, Brasil.
authors.forename: Virgínia Vieitez
authors.initials: VV
authors.lastname: Reis
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002299:Cardia / Q000601:surgery*; D014355:Chagas Disease / Q000150:complications / Q000601:surgery*; D004931:Esophageal Achalasia / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome