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ACHALASIA CARDIA SURGERY  INDIA

ACHALASIA CARDIA SURGERY  INDIA is a primary oesophageal motility disorder, characterised by a hypertensive lower oesophageal sphincter (LOS) which fails to relax on swallowing, and by aperistalsis of the body of the oesophagus.The aetiology of the disease remains unknown. Epidemiological findings rule out an infectious cause, and there appears to be minimal genetic influence. A viral cause is plausible but as of yet electron microscopy has failed to detect viral particles in the vagus nerve or in the oesophageal intramural nerve plexus. The incidence of the disease is 1-2 per 200,000 per year, with both sexes equally affected. Onset of the disease is typically between the ages of 20 and 50.

Signs and symptoms in India

• Mostly patient complains of gradually increasing difficulty in swallowing food (both solids and liquids)
• Feeling of stickiness in throat
• These symptoms tend to increase whenever there is stress or cold
• Undigested food tends to come back into mouth (Regurgitation)
• Chest infections / pneumonia tend to occur due to aspiration of food into windpipe
• Heartburn / acidity sensation
• Severe retro sternal chest pain in 30-40% of patients
• Weight loss in advanced esophageal disease
• Patients with achalasia are at increased risk for esophageal cancer

Endoscopic ultrasound in India

• Thickened muscle layers in the lower part of esophagus.
• CT scan
• CT scanning with oral contrast achalasia cardia surgery india enhancement may demonstrate the gross structural esophageal abnormalities associated with achalasia, especially dilatation, which is seen in advanced stages.

Treatment

Treatment options for achalasia include pharmacologic, mechanical, botulinum toxin, and surgical-based therapies.

Four main classes of drugs have been used for this purpose and include the following : –

• Calcium channel blockers – Nifedipine and verapamil
• Anticholinergic agents – Cimetropium bromide
• Nitrates – Isosorbide dinitrate
• Opioids – Loperamide

Botox injection

• Botulinum toxin therapy works by inhibiting the release of acetylcholine from presynaptic nerve terminals.
• An endoscopist injects botulinum toxin into the LES.
• Effective in 60-80% of patients but recurrence rate is high (50%)
• It can be used as a diagnostic test to identify those patients who will respond to surgical therapy

Surgery

The goal of surgical therapy in achalasia is to decrease LOS resting pressure without completely compromising its competency against gastroesophageal reflux (GOR). The Heller procedure was described in 1913 and now a modification of this procedure is used most commonly in the surgical achalasia cardia surgery india management of achalasia.19, 20 An anterior myotomy is performed by dividing the circular muscle of the oesophagus down to the level of the mucosa. The myotomy extends less than 1cm onto the stomach and to several centimetres above the palpable region of the lower sphincter. The transthoracic approach is preferred, as it helps confirm the diagnosis, allows careful palpation and inspection of the oesophagus, and enables the surgeon to extend the myotomy proximally as far as is necessary. Open myotomies have good results in 80-90% of patients.21,22 They decrease the LOS pressure more reliably, and therefore have a greater efficacy than pneumatic dilatation.

Minimally invasive surgical procedures are becoming a preferable alternative to open myotomy, allowing the Heller myotomy to be performed thoracoscopically and laparoscopically .24,25,26 Shorter hospitalisation, less pain and early resumption of activity are the benefits of the minimally invasive approach, which remains as effective as the open techniques in the relief of dysphagia.27 Complications of minimally invasive surgery include: anterior gastric perforation, mucosal perforation at the gastroesophageal (GO) junction and, most significantly, GOR. Surgery is not necessary for a patient who has few symptoms and minimal oesophageal dilatation. It is, however, required for those with dilatation and food retention to prevent serious pulmonary complications and, of course, to provide symptomatic relief.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_message style=”square” message_box_color=”mulled_wine”]

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