Experience in treating neuromuscular diseases of the esophagus with minimally invasive methods

Objective. Improving treatment outcomes of patients with neuromuscular diseases of the esophagus (NMDE). Material and methods. 159 operations performed at NMDE: 152 patients had achalasia of the esophagus (AE), 4 had diffuse esophageal spasm (DES), and 3 had achalasia of the upper esophageal sphincter. The third stage of achalasia was observed in 113 (74.3%) patients, the fourth — in 39 (25.7%). Results. All surgical interventions for AE performed using a laparoscopic approach, esophagocardiomyotomy was supplemented by Dor fundoplication. DES performed a thoracoscopic access — an extramucous esophagomyotomy (Biokka operation). Pharyngeal achalasia was performed by cervicotomy. Duration of the operation was 107±35.6 minutes; the average hospitality day was 4.2. With AE, 16 patients (10.5%) had mucosal damage, 6 patients underwent conversions (3.9%), 10 patients (6.6%) had defects sutured videoendoscopically. In the postoperative period, 1 patient (0.7%) developed an esophageal fistula closed by vacuum therapy. The long—term treatment results of 130 (85.5%) patients with AP who underwent endovideosurgery were studied: transient dysphagia was noted in 2 patients (1.5%), heartburn — 4 (3.1%), recurrence of the disease requiring surgery — 1 (0.7%). Conclusions. In the case of NMDE, endovideosurgery operations should be performed according to strict indications and contraindications. Providing individual access, considering the patient’s body type, anatomical features, the nature and localization of the pathological process, reduces the number of intraoperative complications, the occurrence of which is not always an indication for conversion.