Summary

The most performed surgery for the treatment of achalasia is Heller´s esophageal myotomy associated or no with anti-reflux fundoplication. We propose in cases of advanced megaesophagus, specifically in the dolico megaesophagus, a technical variation. The aim of this study was to describe Heller´s myotomy modified by Madureira associated with Dor´s fundoplication as an alternative for the treatment of dolico megaesophagus, assessing its effectiveness at through dysphagia scores and quality of life questionnaires.

Materials and methods: Technical Note describing the surgical procedure and presenting the results of three patients with advanced dolico megaesophagus, operated from 2014 to 2017. The technique proposes the dissection of the esophagus intrathoracic, with circumferential release of it, in the most extensive possible by trans hiatal route. Then the esophagus is retracted and fixed circumferentially in the pillars of the diaphragm with six or seven point. The goal is at least on the third part of the esophagus, to achieve its broad mobilization and rectification of it; then is added a traditional Heller myotomy.

Results: The mean dysphagia score in pre-op was 10points and in the post- op was 1.3 points (maximum of 10 points being observed each between the pre and postoperative 8.67 points, 86.7%) The mean hospitalization time was one day. There was no surgical mortality or conversion to open technique. The mean follow-up time was 30.6 months (24-38 months) (Table 1). Heller’s Cardio myotomy modified by Madureira, associated with Dor’s fundoplication is an option to be investigated for the treatment of the dolico megaesophagus.

Keywords: Megaesophagus; Esophageal myotomy; Heller’s myotomy; Dor’s fundoplication; Dysphagia