Achalasia is an esophageal motor disorder of unknown etiology characterized by impaired swallow-induced LES relaxation and diminished or absent esophageal body peristalsis. Heller’s myotomy, with or without antireflux procedure, represents the "gold standard" for surgical treatment. The surgical treatment for stage III achalasia with markedly dilated and sigmoid-shaped esophagus is a matter of controversy. Some authors recommend esophagectomy as the primary treatment because they believe that Heller myotomy cannot improve dysphagia in such cases. We present 2 patients with sigmoid achalasia in whom we successfully performed a esophagogastrostomy with Dor fundoplication.

Methods:

The esophagogastric junction and the distal esophagus up to the tracheal bifurcation were dissected. In 1 case endoscopic stapler (Endo-GIA II) and in 2. case GIA was inserted through a small gastrotomy at the cardia, with one branch placed in the gastric fundus and the other, under esophagoscopic control, in the esophagus. By two consecutive stapler applications, a wide side-to-side esophagogastrostomy was created. To prevent gastroesophageal reflux, a Dor semifundoplication was performed.

Results:

The mean operation time was 55 min. Oral food intake was started on postoperative day 3.In both cases radiologic study showed rapid passage of the barium meal and no reflux through the gastroesophageal junction.

Conclusions:

Esophagogastrostomy with Dor fundoplication represents an alternative to esophagectomy and Heller-Dor surgery. Because of the wide sideto- side anastomoses, there is no risk of persisting stenosis such as that reported for the Heller operation, and the procedure certainly is less invasive than esophagectomy. Laparoscopic esophagogastrostomy and Dor fundoplication is an alternative minimally invasive treatment for sigmoid achalasia.

Keywords: Achalasia, Sigmoid achalasia, Dor funduplication, Esophagogastrostomy