Inversed Y cardioplasty plus a truncal vagotomy-antrectomy and a Roux-en-Y gastrojejunostomy performed in patients with stricture of the esophagogastric junction after a failed cardiomyotomy or endoscopic procedure in patients with achalasia of the esophagus

• Published in: Diseases of the esophagus 2010-04, Vol.23 (3), p.208-215
• Main Authors: Braghetto, I., Korn, O., Cardemil, G., Coddou, E., Valladares, H., Henriquez, A.
• Format: Article
• Language: English
• Subjects: achalasia; Adult; Aged; Aged, 80 and over; Cardia - surgery; Cohort Studies; Esophageal Achalasia - complications; Esophageal Achalasia - pathology; Esophageal Achalasia - surgery; Esophageal Stenosis - etiology; Esophageal Stenosis - pathology; Esophageal Stenosis - surgery; Esophagogastric Junction; failure; Female; Gastric Bypass - methods; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - pathology; Gastroesophageal Reflux - prevention & control; Gastroplasty - methods; Humans; inversed Y cardioplasty; Male; Middle Aged; Reoperation; Retrospective Studies; Roux-en-Y gastrojejunostomy; Secondary Prevention; surgery; Vagotomy, Truncal; Young Adult
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2009.01021.x

SUMMARY Laparoscopic anterior cardiomyotomy in addition to anterior Dor's fundoplication is the procedure of choice for achalasia of the esophagus with approximately 95% success rate. Redo cardiomyotomy is complicated and associated with rerecurrence of dysphagia. Twelve patients with failed redo myotomy were clinically evaluated with radiology, endoscopy, and manometry in whom achalasia type III or IV was confirmed. We propose as treatment for these selected cases an inversed Y cardioplasty + truncal vagotomy, a partial distal gastrectomy and Roux‐en‐Y gastrojejunostomy in order to facilitate esophageal emptying and avoid the appearance of postoperative gastroesophageal reflux as a side effect of this procedure. One patient was reoperated on in order to enlarge the cardioplasty. Disappearance of dysphagia was confirmed in all patients. Three patients presented reflux symptoms and were treated with 20 mg of Omeprazole 20 twice/day. No food retention, erosive esophagitis, or Barrett's esophagus were observed. The mean resting pressure decreased from 24.9 ± 8.5 mm Hg to 7.5 ± 2.5 mm Hg (P = 0.0001). Furthermore, esophageal diameter decreased significantly after a 5‐year follow‐up. This procedure could be an option for treating patients in which repeated Heller operations have failed.