Pantoja Pachajoa Diana A, Vargas Aignasse Ramiro A, Alonso Solla Irene, Gielis Manuel, Muñoz Juan A, Viscido German R
General Surgery department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina.
General Surgery department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina.
Int J Surg Case Rep. 2024 Dec;125:110545. doi: 10.1016/j.ijscr.2024.110545. Epub 2024 Oct 31.
Achalasia is a rare esophageal motility disorder causing dysphagia and weight loss. Severe cases may present with a significantly dilated and sigmoid-shaped esophagus (sigmoid achalasia). Traditionally, esophagectomy was used for such cases. However, laparoscopic Heller myotomy (LHM) is emerging as a less invasive alternative with comparable outcomes.
We present a 45-year-old male with a seven-year history of dysphagia, regurgitation, chest pain, and recent weight loss. Barium esophagogram, high-resolution esophageal manometry, and upper endoscopy confirmed severe achalasia with a sigmoid esophagus (Type I according to Chicago classification). Esophagectomy was considered, but due to the patient's age and the lack of prior treatment attempts, LHM with Dor's fundoplication was performed successfully. At 24-month follow-up, the patient reported significant symptom improvement and weight gain.
While esophagectomy was historically used for severe achalasia, LHM is increasingly being employed due to its minimally invasive nature and favorable outcomes. This case highlights the potential benefits of LHM in carefully selected patients with severe achalasia, even those with sigmoid esophagus. However, it's important to acknowledge that LHM may not be suitable for all end-stage cases, and esophagectomy might be necessary in some situations. CONCLUSIóN: Laparoscopic Heller myotomy with Dor's fundoplication is a promising treatment option for end-stage of achalasia, offering faster recovery and improved quality of life. However, further long-term studies are needed to confirm its long-term effectiveness.
贲门失弛缓症是一种罕见的食管动力障碍性疾病，可导致吞咽困难和体重减轻。严重病例可能出现食管显著扩张并呈乙状结肠形（乙状结肠型贲门失弛缓症）。传统上，此类病例采用食管切除术。然而，腹腔镜下Heller肌切开术（LHM）正逐渐成为一种侵入性较小且效果相当的替代方法。
我们报告一名45岁男性，有7年吞咽困难、反流、胸痛病史，近期体重减轻。食管钡餐造影、高分辨率食管测压和上消化道内镜检查证实为严重贲门失弛缓症伴乙状结肠形食管（根据芝加哥分类为I型）。考虑过进行食管切除术，但由于患者年龄以及此前未尝试过治疗，遂成功实施了LHM联合Dor胃底折叠术。在24个月的随访中，患者报告症状明显改善且体重增加。
虽然食管切除术在历史上一直用于治疗严重的贲门失弛缓症，但由于LHM具有微创性且效果良好，其应用越来越广泛。该病例突出了LHM在精心挑选的严重贲门失弛缓症患者（即使是乙状结肠型食管患者）中的潜在益处。然而，必须认识到LHM可能并不适用于所有终末期病例，在某些情况下可能需要进行食管切除术。结论：腹腔镜下Heller肌切开术联合Dor胃底折叠术是贲门失弛缓症终末期一种有前景的治疗选择，可实现更快康复并改善生活质量。然而，需要进一步的长期研究来证实其长期有效性。
