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Resection for achalasia of the esophagus.

One hundred and twenty-two patients with advanced mega-esophagus managed by esophagectomy without thoracotomy and cervical gastroplasty were evaluated. Sixty-nine patients were followed up for periods of 6 months to 16 years. Clinical assessment included X-ray studies and endoscopy of the cervical esophagus and mobilized stomach. The most common postoperative complications were pleural effusion (22.1%) and cervical fistula (8.2%). Mortality was 4.18%. Regurgitation was the most frequent complaint in the late follow-up, followed by heartburn. Both symptoms were related to esophagitis and diffuse gastritis. Diarrhea and dumping also occurred due to vagotomy and pyloromyotomy performed at the same time as esophagectomy. The endoscopic study demonstrated esophagitis in 25.5% of the patients, and diffuse erosive gastritis in 12.7%. The symptoms and late complications were handled by clinical measures and careful endoscopic follow-up. Gastroplasty was considered a good procedure for replacing the esophagus, solving the serious problem of dysphagia and for providing nutritional improvement for the patient.