Complications of the esophagus extirpation in patients with neglected stages of achalasia are divided into
intraoperative, immediate and late postoperative complications. The difficulty of the esophagus extirpation in
patients with neglected stages of achalasia is in the difficulty and danger of the esophagus mobilization through
the abdomino-cervical approach which are caused by severe esophagectasia and periesophagitis. In this regard,
we observed the following intraoperative complications: bleeding from the mediastinum in 5 (17.8%) which was
stopped intraoperatively by a mediastinal plugging; injury of the mediastinal pleura in 14 (50%) which required
additional drainage of the pleural cavities; injury of the left recurrent nerve in 4 (6.3%) which caused a
temporary loss of voice and a disorder of the swallowing act and which was normalized during the first 6
months after the operation against the background of therapy in the ENT specialists.
The following complications were observed in the immediate postoperative period: bronchopulmonary
complications in 5 patients (17.8%): pneumonia in 2 patients, exudative pleurisy in 3 patients and specific
complications in 1 patient (3.6%) had the esophagogastro-anastomosis failure.
All complications were stopped by conservative measures. No lethal outcomes were observed. All 28
patients were examined in the long-term period, in terms from 6 months to 20 years. Only in 2 cases (7.2%)
cicatricial narrowing of esophagogastrostomy was diagnosed which required repeated bougienage and
dilatation courses with a good clinical effect.
The main treatment method for the patients with achalasia remains cardiodilation which belongs to the
minimally invasive methods and allows ensuring adequate restoration of food patency. However, in patients
with neglected stages its efficiency is significantly reduced, and the frequency of recurrent dysphagia is
increased. In patients with neglected stages of achalasia when the peristaltic activity of the esophagus is
completely lost severe esophagoectasia is developed, as well as S-shaped deformation of the esophagus and the
cardia itself. The operation of choice for these patients is the esophagus extirpation with simultaneous
gastroesophagoplasty and the formation of extracavitary esophagogastroanastomosis in the neck. Compliance
with all principles of gastroesophagoplasty will minimize the risk of dangerous intraoperative and
postoperative complications. Further control randomized trials and multicentric studies should be performed.
Though the represented study is a singe center results and control randomized trials and multicentric studies
should be performed.
This work was supported by “Republican Specialized Surgery Centre named after Academician
V.Vakhidov”, Tashkent. Uzbekistan.
All authors contributed equally to this work.
The authors declare that they have no competing interests.
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Citation: Nazirov FG, Nizamkhodjayev ZM, Ligay RE, Tsoi AO, Shagazatov DB, Nigmatullin EE and Babadjanov KB. Esophagus extirpation in the surgical