Ways to improve results of endosurgical treatment of achalasia

Aim. To improve the method of Heller cardiomyotomy for best immediate and long-term results of treatment of esophageal achalasia.Materials and methods. Analyzing the results of surgical treatment of 280 patients with esophageal achalasia who were treated in the Department of Surgical Diseases and New Technologies of the Bashkir State Medical University (Ufa) and the Department of Surgery and Stomach of the Republican Clinical Oncology Center (Kazan) for a period from 2000 to 2019. We conducted a cohort retrospective study in 2 groups (laparoscopic esophagocardiomyotomy according to Heller, supplemented by anterior modified hemifundoplication according to Dor (n = 74) and traditional laparoscopic interventions (n = 206).Results. The authors have developed an original method of laparoscopic esophagocardiomyotomy, including the use of devices that facilitate the mobilization of cardia and the formation of fundoplication cuffs. Patients were examined by performing esophagogastroduodenoscopy, contrast X-ray scopy of the esophagus and stomach, esophagomanometry, pH-measurement in distal part of esophagus. Long-term results of up to 2 years were tracked. Surgically treated patients were tested by special application forms. Received results showed the restoration of quality of life in most of the subjects.Conclusion The developed technique of laparoscopic esophagocardiomyotomy, including the use of intra-esophageal transillumination and a device for measuring the esophagus, prevents damage to the esophagus wall and postoperative complications associated with insufficient or excessive narrowing of the esophagus. Of the 74 patients, 66 (89.2 %) rated the result as excellent and good, 6 (8.1 %) as satisfactory, and 2 (2.7 %) as unsatisfactory.