Kurbanov A. Comparative evaluation of long-term results of minimally invasive and open surgical methods of treatment esophageal achalasia

The thesis is devoted to the problem of improving treatment achalasia by improving diagnosis, methods of surgical treatment with open transabdominal Heller myotomy (OHM) and laparoscopic (LHM) and criteria of evaluating the effectiveness at the long-term period. The work based on the analysis of 106 patients with stages esophageal achalasia: I - 8 (7.5%), II - 25 (23.6%), III - 55 (51.9%), IV-18 (17.0%). The methods of treatment included surgery procedures (95) and pneumatic dilatations (11). We performed OHM with dosed sagittal diaphragmotomya and like Dor antireflux plasty (56); LHM (39) with covering of liberated mucous membrane by plates Surgicel nu-knit ™ or Tachocomb ™ (16), Dor (18) and Toupet (5) antireflux plasty. Dynamic of follow up results of treatment with 4-point assessment of degrees severity not only clinical symptoms, but also the changes ectasia of esophagus, passage into stomach and of endoscopic mucosal were followed over periods of 2, 5, 10, 15, 20, 25-30 years after treatment. Compared with preoperative degrees (3-4 points) of severity of signs achalasia the significant positive improvements (1-2 points) occurred in first 2 years (p <0.05, 0.001), but later, from 5 to 30 years, the number of persons increased with manifestations of symptoms for degrees severity in the 2 points (III) and 2-3 points (IV). Radiological and endoscopic positive changes of 2-year phase have remained stable. The positive changes of clinical symptoms in III-IV st. were in 1.9 times more remarkable after OHM (p < 0.01). We observed relapse dysphagia for dilation after LHM and plates Surgicel nu-knit ™ or Tachocomb ™ (50.0%), LHM with antireflux plasty (13.0%), OHM with antireflux plasty (8.9%) (p < 0.01).The quality of life for the integral indicators of physical and mental health components in a long-term period depended not on the operation, and from age-related characteristics of patients.