POSTOPERATIVE COMPLICATIONS IN THE TREATMENT OF CHAGASIC MEGAESOPHAGUS

The postoperative complications of Chagasic megaesophagus were studied in 250 Chagasic patients referred to the Gastroenterology Clinic of H ospital das Clinicas, Federal University of Minas Gerais, Belo Horizon te, Brazil. The treatment was balloon dilatation in 45 (18.0%), myotom y and cardioplasty in 63 (25.20%), Merendino's surgery in 139 (55.60%) , esophagogastroplasty in 2 (0.8%) and esophagocoloplasty in 1 (0.4%). There were 125 (50%) early and 30 (12%) late postoperative complicati ons, and in 65 patients (26%) recurrent dysphagia was noted: nineteen (6.6%) after myotomy and cardioplasty, 9 (3.6%) after Merendino's oper ation and 37 (14.8%) after balloon dilatation. Eighty-five patients (3 4%) needed reoperations either to correct recurrent dysphagia (56 pati ents, 22.4%) or to treat other complications (29 patients, 11.6%). The reoperations to correct the 19 recurrences after myotomy and cardiopl asty were Merendino's operation (12 patients, 4.8%), forceful dilatati on (1 patient, 0.4%), forceful dilatation followed by Merendino's (2 p atients, 0.8%), another myotomy (2 patients, 0.8%), myotomy followed b y Merendino and balloon dilatation (I patient, 0.4%) or esophagogastro plasty (1 patient, 0.4%). The recurrences after dilatation were treate d by myotomy (15 cases, 6%), Merendino' s operation (12 cases, 4.8%) a nd myotomy followed by Merendino's (3 cases, 1.2%). After Merendino se ven reoperations (2.8%) were done: reduction of interposed loop (6 cas es, 2.4%) and esophagocoloplasty (1 case, 0.4%). The time elapsed betw een the first operation and reoperation or dilatation varied from a fe w weeks to 18 years. Thirteen patients (5.2%) were reoperated within o ne month after the first surgery, 17 patients (6.8%) up to 6 months fo llowing the initial surgery and the remaining 55 patients (22%) were r eoperated in a period varying from 6 months to 18 years. Bearing in mi nd that megaesophagus is a benign disease it seems likely that there i s no ideal treatment of Chagasic megaesophagus as the recurrence, comp lication and death rates are so high.