Oesophagectomy for end stage Achalasia

Achalasia is the commonest primary esophageal motility disorder, characterized by the failure of lower oesophageal sphincter (LOS) to relax along with loss of peristalsis in the oesophageal body and increased resting pressure of the LOS. Patients present with long-standing progressive dysphagia for both liquid and solid ,other symptoms include regurgitation, respiratory symptoms due to chronic aspiration and weight loss due to nutritional failure. End stage achalasia is characterized by dialated and tortuous sigmoid oesophagus in patients previously treated with either pneumatic dilation or myotomy and failure of further such therapy to relieve symptoms. Oesophagectomy for such cases can help achieve good symptom control, improve nutrition and enable a good quality of life. We present a series of 3 cases of end stage achalasia managed by transhaital oesophagectomy and gastric pull up followed by cervical oesophago-gastric anastomosis and review the literature on management of end stage achalasia.