Esophagectomy with gastric reconstruction for achalasia

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Presentation transcript:

Esophagectomy with gastric reconstruction for achalasia Michael K. Banbury, MDa, Thomas W. Rice, MDa, John R. Goldblum, MDb, Sarah B. Clark, MDb, Mark E. Baker, MDc, Joel E. Richter, MDd, Lisa A. Rybicki, MSe, Eugene H. Blackstone, MD a,e The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 6, Pages 1077-1085 (June 1999) DOI: 10.1016/S0022-5223(99)70243-6 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 A, Chest x-ray film shows a mass in the posterior mediastinum ( arrows). B, Barium esophagogram confirms a very dilated sigmoid esophagus. C, Computed tomographic scan without oral contrast material again demonstrates the dilated fluid-filled esophagus. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1077-1085DOI: (10.1016/S0022-5223(99)70243-6) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 A, Myenteric plexus from a control esophagus. The normal myenteric plexus shows easily identifiable ganglion cells (arrow) with essentially no inflammation. B, Myenteric plexus from a patient with achalasia showing severe neuritis. There is a marked lymphocytic infiltrate with admixture of eosinophils and plasma cells. C, Myenteric plexus from a patient with end-stage achalasia showing a scarred myenteric nerve. No ganglion cells are identified and the degree of lymphocytic inflammation is minimal. D, Trichrome-stained section from the same esophagectomy specimen as seen in C, showing a scarred nerve and minimal lymphocytic inflammation. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1077-1085DOI: (10.1016/S0022-5223(99)70243-6) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Colon interposition for end-stage achalasia. Massive dilatation and tortuosity developed in both the thoracic and abdominal portions of this colon interposition 3 years after esophageal replacement. There was return of preoperative symptoms. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1077-1085DOI: (10.1016/S0022-5223(99)70243-6) Copyright © 1999 Mosby, Inc. Terms and Conditions