Esofagectomia transhiatal laparoscópica para o tratamento do megaesôfago avançado: análise de 60 casos

Abstract

We studied and demonstrated that the technique of subtotal esophagectomy, through laparoscopic and transmediastinal access, in order to prepare the stomach, to dissect the abdominal and thoracic esophagus, and to perform a left cervicotomy for esophageal removal and to proceed with an esophagogastric anastomosis is a good choice and it is a safe method for advanced megaesophagus treatment. Sixty transhiatal esophagectomies by laparoscopy were performed between September 1996 and December 2006, with preservation of the vagus nerve in the last ten cases. The mean age of the patients was 56.4 years-old (18-76) and they were submitted to preoperative blood tests for T. Cruzi, esophagography, high-resolution digestive endoscopy, electromanometry, biliary ultrasound, and 24-hour ph-metry. Also a nutritional evaluation, respiratory physiotherapy and enteral nutritional support, using a nasoenteral tube were done. The indications for this surgery were radiologically and functionally advanced megaesophagus, recurrence of megaesophagus after surgery involving the esophageal junction and association of severe dysplasia and/or neoplasia. The follow-up period was from six to 118 months. There was no mortality, the mean surgery time was 160 minutes (110 to 325), and improvement was noted in all evaluated parameters. Twelve of 60 (20%) patients presented with complications; eight cases had hemopneumothorax (13.33%); three cases had gastric stasis (5%); four cases had cervical fistulae (6.67%), and resolution was achieved with non operative treatment; nine cases had dysphonia (15%). The results observed in laparoscopic transhiatal esophagectomy were encouraging. They demonstrated that this is a practical and safe technique with excellent postoperative results.