Shevchenco A. Surgical treatment of cardiac achalasia.

Object of the study: oesophageal achalasia (OA). Purpose of the study: improvement of the results of surgical treating of patients with OA (POA) with help of the development of the optimum medical-diagnostic algorithm and the use of modified ways of instrumental-surgical correction. Methods of the investigation: clinical, laboratory, biochemical, ultrasonographic, morphological, instrumental (roentgenological, manometric), functional (fibrooesophagogastroscopy), electron microscopic, and statistical. Theoretical and practical results: an optimum surgical tactics was worked out, thereby making it possible to individualize indications for surgical treatment of POA. The devised modified techniques for instrumental and surgical treatment of OA can be applied to the practice of health establishments and will make it possible to improve the results of treating patients. Differentiated indications for the choice of the surgical correction method were elaborated; their use will reliably improve the treatmentresults. Advantages of the surgical techniques, providing for the restoration of the physiological components of the cardia at “late” stages of OA, were revealed. Novelty: an original technique for the surgical treatment of OA was suggested and introduced. The design of a device for pneumocardiodilation and the technology of cardiodilation execution were perfected. A medical-diagnostic algorithm for the choice of treating POA was elaborated; its application makes it possible to significantly improve the results of the surgical treatment. It was proved that the results of treatment could be improved by introducing the devised etiopathogenic approach. A complex diagnostic tactics was devised for the choice of the way of treating POA and preventing complications, thereby making it possible to individualize it depending upon the morphofunctional state of oesophagocardial region. Indications for the kind, scope and character of cardiodilation and surgical treatment depending upon the stage of OA were determined. Onthe basis of the study of remote results, the most effective methods the of treatment depending upon motor dysfunctions of the thoracic oesophagus were determined, thereby making it possible to decrease the number of complications from 9.5 % to 2.6 %, and the number of relapses from 15.9 % to 5.3 %. Degree of introduction: results of the researches were introduced into the work of the Department of Oesophageal and Gastrointestinal Diseases of the Research Institute of General and Urgent Surgery of the Academy of Medical Sciences of Ukraine. The main propositions of the conducted researches are used in the teaching process at the Department of Hospital Surgery of Kharkiv National Medical University. Sphere of application: medicine, surgery.