The results of thoracoscopic treatment for achalasia are equivalent to historical outcomes obtained with open surgery but the patient is spared major thoracotomy or the acid reflux associated with a laparoscopic approach. Thoracoscopic approach of esophageal myotomy is a very good minimal access surgical approach and this presentation describe all the major principle involve in this surgery.
Esophageal myotomy with fundoplication extramucosal offers the best long-term results to ease achalasia; several large series have shown that it is done with little hassle and great results. In 1991, Heller myotomy minimally invasive introduced and is now recognized as one of the most viable treatment for achalasia because of his shorter hospital stay and recovery. The surgeon treats patients with achalasia and lung abscess surgery, leading monitor and thoracoscopy esophagomyotomy fundoplication after lung lobectomy.
A patient at 52 year of age, vomited after eating, suffering from fever and cough, and lost 10 kg in two months. Chest radiography showed cavitary lesion shade and abnormal chest X-rays in the top right lung. Computed tomography (CT) of the chest confirmed cavitary lesion and dilation of the esophagus. Transbronchial biopsy tumor showed inflammatory changes, but no malignancies. Fluoroscopic examination showed dilatation of the middle and lower esophagus and narrow short segment of the gastroesophageal junction and stomach absence of air bubbles. Lining the narrow segment was soft. Barium appear to show the lock, but its slow observed over time. There was no change in the narrow segment cancerous endoscopic findings.
Esophagus achalasia and suspected lung abscess, lung abscess Treatment with antibiotics for two weeks was diagnosed. Size cavity has not changed significantly, and the patient symptoms, cough and chest pain persisted. It was found that the patient was resected lung injury and narrowing of the esophagus repaired alleviate their suffering extended so that it can return to work as soon as possible. Cavitary lesion resection was performed right thoracotomy. It was found that the upper lobe of the right to adhere to the chest wall of the lung, and the light Change Belsey Mark IV procedure.
Modified Belsey repair was carried out by two points vertical mattress in the initial layer above the LES, saving unclear, enter the mode of less than 270 degrees. The second layer of weld is approximately 1 cm above the housing and ensures the diaphragm. The envelope is reduced in the stomach and the second layer are attached surgical child. Pleural effusion. We spent upper lobectomy. Pathological examination of surgical specimens confirmed the lung abscess and no malignant transformation.
After 2 weeks, myotomy and partial fundoplication (Belsey Mark IV modified procedure) was performed by video-assisted thoracoscopic surgery achalasia. Before the second operation, the patient's lung function deteriorates with a reduced volume of 2280 ml 3600 ml. The patient is placed on the right decubitus position. Ventilation was not affected by the operation of the lungs. Three Trocars inserted through the left sixth, seventh and ninth intercostal space. Minithoracotomy (4 cm) was carried out in the eighth row of ribs. Esophageal myotomy is 8 cm proximal stomach taken after 2 cm. Termination was closed by placing additional simple sutures through the diaphragm, esophagus and fundus tissue to Belsey Mark IV gastric procedure changed. The operation lasted 2 hours and 47 minutes and blood loss was 150 cc. When post-operative fluoroscopy, barium goes smoothly. He was discharged patient back 2 weeks after the second operation. No postoperative complications occurred and the patient has shown excellent results in the follow-up review of 16 months.
Discussion
Many lung abscesses include predisposing factor. It is well known that the majority of primary lung abscesses are the result of pulmonary aspiration, a decrease of consciousness as the main predisposition. Primary treatment involves careful handling. Surgical treatment is usually suspended for a number of indications, including a very large abscess, long-term symptoms, venomous local changes bronchiectatic and occasionally hemoptysis. Although the degree of the condition is not serious in this particular case, it was lung abscess. Due to possible aspiration pneumonia causes lung abscess in the second lobe and the patient loses a lot of lung function, select esophageal myotomy than pneumatic dilation. Antireflux surgery are designed to improve the physiological function of the lower esophageal sphincter and gastroesophageal junction. The procedure Belsey Mark IV is reported to be safe and effective in the treatment of gastroesophageal reflux complications. Has also recently introduced a Heller myotomy by laparoscopy or thoracoscopy.
Some surgeons recommend abdominal dilatation of the esophagus tends to develop in the right chest, instrumentation for laparoscopic myotomy is parallel to the axis of the esophagus, and the extent of myotomy facilitated. The thoracic approach, however, the need for division of pulmonary ligament and lower front visualize the esophagus minimal dissection, the risk of esophageal or spleen damage is low, and invasiveness less than thoracotomy or laparotomy. thoracoscopic surgical approach in time and shorter than laparoscopy. We respect the chest approach advantages and therefore directed myotomy and partial fundoplication thoracoscopic tubs (Belsey Mark IV modified procedure).
Belsey Mark IV antireflux procedure product could very well to excellent results in 70% of cases, and one of the most commonly used methods in the last decade. Both lung abscess complicated akalazija and should be treated at the same time, we believe that the patient would suffer serious damage in nondivisional surgery and it was unclear whether the cavitary lesion is cancerous, so we chose a division operation. We have operated on the patient, shortly after lobectomy.
Generally, respiratory influences during and after surgery. All number of studies have shown that the incidence of pulmonary complications increases with surgical treatment of the lungs and the abdomen superior! Minimally invasive, however, involves less atelectasis, hypoxemia and reduced functional residual capacity and postoperative complications are minimized This procedure is suitable for patients who meet the general requirements for entitlement to the barrel. We conclude that thoracoscopic myotomy and fundoplication can be used in many other cases.
Conclusion
Thoracoscopic myotomy and fundoplication appears to be effective and safe in the treatment of lung function.
