Significant dilation

The main symptoms were dysphagia, were observed in 36 (92.3%) patients, regurgitation - in 32 (82,1%), chest pain when swallowing - in 21 (53,8%) patients.

Diagnosis of achalasia was performed using clinical and instrumental methods (radiography, fibroezofagogastroskopiya, endoscopic and transabdominal ultrasonography, esophageal manometry and intragastric pH-metry) [4], the quality of life was assessed on the basis of studying gastrointestinal index - GIQLI.

All patients underwent an operation on the original technique.
Results and discussion

Before surgery, all patients were brand viagra online fully examined, the results of which were refined stage achalasia and determined the indications for surgical treatment and to choose the way of its implementation.

When endoscopic examination in patients with achalasia cardia with stage II esophageal mucosa in the upper and middle thirds was not changed. Tone of the wall was maintained throughout until the restricted area, where there is a moderate suprastenoticheskoe extension. Cardia was tightly knit and not disclosed by insufflation of air. Tube apparatus, regardless of the diameter of free passage in the stomach, bypassing the narrowed portion, mucous which was also intact.

When achalasia stage III exhibited a significant dilation of the esophagus, which contained an empty stomach mucus and food debris. The mucosa of the esophagus had areas of atrophy in the lower third was edematous, hyperemic, places of contact bleeding. Cardia was close, when insufflation is not disclosed, and the tube apparatus 11 mm in diameter passed into the stomach without effort.

The thickness of the muscle layer correlated with the stage of achalasia and stage II is 3-4 mm at III stage was - 6.5 mm. When achalasia stage III in the majority of cases observed diffuse hyperechoic muscle layer at the site of narrowing, as a sign of connective tissue and scarring of the muscular layer.

When oesophageal manometry in all patients there was an increase srednerespiratornogo pressure in the lower esophageal sphincter than 40 mm Hg decrease in the amplitude of peristaltic waves in the body of the esophagus or distal to the site generic levitra less than 35 mm Hg; relax the lower esophageal sphincter on swallowing was less than 60%.

According to a short-term intragastric pH-metry in 31 (79.5%) of 39 patients had giperatsidnyh against the background of basal secretion. On the background of stimulation of patients with giperatsidnyh reached 92,3% (36 patients).

When X-rays detected by a persistent narrowing of the cardia during the 3-4 cm proximal to the restrictions determined by the cylindrical extension of the esophagus throughout, achieved with stage II, 3-5 cm, with stage III 5-6,5 cm with decreased tone of the wall (Fig. 2 ).

Peristaltic waves are slowed down with increased over the narrowed cardia and subsequent weakening. Initial evacuation of the esophagus occurred after 5,8 ± 1,3 min (from 4,5 to 7,5 min) in small and infrequent amounts.

After determining the indications for surgical intervention and conducting pre-operational training of the patients were operated on.

Indications for the surgical treatment of the proposed procedure for achalasia stage was II are:


* Inefficiencies or low effectiveness of conservative treatment (relapse less than 6 months), while conservative treatment consisted of an air cardiodiosis 4-6 sessions at intervals of 4-5 days and 3-5 min exposure with the subsequent appointment or Nitrosorbid corinfar (1 tablet before eating) and sedatives;
* The patient's refusal to fulfill cardiodiosis;
* Severity of clinical symptoms (dysphagia, pain, regurgitation);
* Escort peristaltic activity in the wall of the esophagus above the restriction according to X-ray studies and oesophageal manometry.

When achalasia stage III when surgery is indicated:


* Ineffectiveness or inefficiency of conservative treatment (relapse less than 3 months);
* The patient's refusal to fulfill cardiodiosis;
* Signs of scarring of the muscular layer of the esophagus at the site of the restriction according to endoscopic ultrasonography;
* Preservation of peristaltic activity in the wall of the esophagus above the restriction according to X-ray studies and oesophageal manometry.

reproductive function
insidious iron
lactic acidosis
thrombotic events