Esophagectomy with gastric reconstruction for achalasia

Purpose: Achalasia is a degenerative esophageal disorder that may result in esophageal failure necessitating resection for restoration of gastrointest inal function. This study evaluates a protocol of esophageal resection and gastric reconstruction for end-stage achalasia, Methods: Hospital records, radiographic studies, and resection specimens of patients undergoing esopha gectomy and gastric reconstruction were reviewed, Patient outcome was defin ed by an evaluation of symptoms (early satiety, dysphagia, regurgitation, a nd reflux), dietary restrictions, and ability to maintain or gain weight, P reoperative, operative, and postoperative variables and pathologic features in the resection specimens,were analyzed to determine predictors of outcom e, Results: In a 10-year period, 32 patients underwent esophagectomy with g astric reconstruction for achalasia; 30 (94%) underwent elective surgery an d 2 (6%), emergency surgery, No postoperative deaths occurred. Of 29 patien ts completing telephone interviews, 24 (83%) had no or mild dysphagia; 21 ( 72%), no or mild regurgitation; 20 (69%), no or mild reflux; and 19 (66%), no or mild early satiety, Twenty-four (83%) patients had no or minimal diet ary restrictions; 26 (90%) had no or minimal social dietary restrictions. P ostoperative weight was not different from preoperative weight. Of 30 patie nts, 26 (87%) felt better after esophagectomy and 25 (83%) would have the o peration again. There were few predictors of outcome. Younger patients were more likely to have dysphagia (P = .03), Conclusions: Esophagectomy with g astric reconstruction relieves preoperative dysphasia and regurgitation in the majority of patients. Dietary function and weight maintenance are excel lent, attesting to the durability of the procedure in patients with end-sta ge achalasia.