Late results on the surgical treatment of chagasic megaesophagus with the Thal-Hatafuku procedure

BACKGROUND: Chagas' disease has a wide distribution in Central and South Am erica. It is endemic in 21 countries, with 16 to 18 million persons infecte d and 100 million at risk. Surgical treatment of achalasia from Chagas' dis ease is the first choice in advanced stages. The aim of this study was to a nalyze the late clinical followup of 50 patients operated on for Chagas meg aesophagus with the Thal-Hatafuku procedure. STUDY DESIGN: During the period of January 1966 to January 1993, 50 patient s suffering from advanced achalasia from Chagas' disease were submitted to the Thal-Hatafuku procedure. The patients answered a questionnaire concerni ng the most relevant postoperative symptoms. The Thal-Hatafuku procedure wa s performed as the first surgical option (46 patients), and on reoperations because of failure of other surgical techniques (4 patients). RESULTS: The mean followup was 63.11 months for the 44 patients with longte rm followup. Postoperative complications included surgical site infection ( 3 of 50 patients), urinary infections (3 of 50 patients), atelectasis (2 of 50 patients), pleural effusion (2 of 50 patients), and deep venous thrombo sis (1 of 50 patients). The main symptoms found in the postoperative period were dysphagia (20 of 44 patients), heartburn (11 of 44 patients), vomitin g (13 of 44 patients), and retrosternal pain (6 of 44 patients). Eleven pat ients of the 44 remained asymptomatic at the end of the followup period. Ou tcomes were analyzed according to the modified Visick classification. Visic k classes I and II represented 25% and 27.3%, respectively. Eighteen patien ts (40.9%) were classified as Visick III. CONCLUSION: We conclude that the Thal-Hatafuku operation is a therapeutic o ption that should be considered in the treatment of achalasia of the esopha gus secondary to Chagas' disease, in advanced cases. (J Am Coll Surg 2001; 193:493-498. (C) 2001 by the American College of Surgeons).