Does transhiatal esophagectomy represent an efficient line of treatment for end-stage achalasia? a single-center study of the outcomes

Background
Achalasia is a rare primary esophageal motility disease that could lead to a state of complete esophageal failure known as end-stage achalasia. The proposed treatment lines have been changed over the past few decades. Since it was described in 1976, the transhiatal esophagectomy (THE) has been evaluated in many esophageal disorders. However, there were scarce data regarding its effects on patients with end-stage achalasia.
Objective
In this prospective trial, we tried to spotlight on this mysterious disease and to unveil the real outcomes of THE in patients with an end-stage achalasia complicated with sigmoid changes regarding the efficacy and the complications.
Patients and methods
A prospective study had been conducted at Ain-Shams University Hospitals, Cairo, Egypt, between January 2018 and December 2019 on 17 consecutive patients who have been diagnosed with end-stage achalasia. Those patients were scheduled for THE. The dysphagia score was assessed preoperatively and at each postoperative follow-up visit along with the other relevant surgical data.
Results
In this series, there were 10 (58.8%) males and seven (41.1%) females, with a median age of 61.3 years, the mean duration of symptoms was 73.3 months (range, 32–135 months), and the mean preoperative dysphagia score was 3.0. One of our patients died owing to pneumonia on the 27th day postoperatively. Another patient was converted to the transthoracic approach owing to severe adhesions hindering the safe dissection. The general morbidity rate was 52.9%, including three (16.7%) cases of cervical leakage, two (11.7%) cases of bleeding, nine (52.9%) cases of pleural effusion, and four (23.5%) cases had surgical site infection. All these cases were managed conservatively, with no need to reoperate. There was one patient who had a transient vocal cord paresis that improved spontaneously after 6 months.
Conclusion
This prospective trial verified that THE is a safe and efficient surgical treatment with an acceptable rate of mortality and morbidity.