Assessment of The Outcome After Stapled Cardioplasty for Recurrent and Advanced Cardiac Achalasia.

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

10.21608/ejsur.2025.350880.1347

Abstract

Background: Achalasia is a primary esophageal motor disorder with unknown etiology, characterized endoscopically
by a dilated esophagus with retained saliva and undigested food in the absence of stricture or tumor, radiographically
by oesophageal dilatation with minimal LES opening, and manometrically by ineffective peristalsis and insufficient
relaxation of the LES.
Aim: To assess the outcome of stapled cardioplasty in the management of recurrent and advanced cardiac achalasia regarding improvement of the symptoms and incidence of complications.
Patients and Methods: Conducted at Ain Shams University Hospitals, this cohort study began in July 2022 and included
a single group of 15 patients. These patients met strict inclusion criteria: they presented with recurrent achalasia following
failed previous interventions, or advanced achalasia with an esophageal diameter greater than 6cm. Patients unfit for
general anesthesia (ASA III—V) were excluded.
Results: The study demonstrated significant improvement in symptoms among patients undergoing stapled cardioplasty
for recurrent and advanced cardiac achalasia. The median preoperative Eckardt score of 8.0 significantly decreased to 3.0
postoperatively (P< 0.001). None of the patients experienced postoperative complications such as infection or anastomotic leakage. Hospital stays were brief, ranging between 2 and 3 days. Only 6.7% of patients showed appreciable symptoms of reflux postoperatively. Additionally, dysphagia recurrence was observed in only one (6.7%) patient.
Conclusion: The study confirms that stapled cardioplasty is a highly effective and safe surgical option for managing recurrent and advanced achalasia. The procedure achieves significant improvement in dysphagia with minimal complications, showcasing its viability as an esophagus-preserving alternative to more invasive options like esophagectomy. Selective incorporation of fundoplication proved effectiveness in minimizing gastro-oesophageal reflux disease without impeding esophageal emptying. These findings add valuable evidence to the limited literature on advanced achalasia interventions, offering a practical solution for patients with challenging presentations.

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