Pearls and Pitfalls
Chagas' disease is related etiologically to the protozoan hemoflagellate, Trypanossoma cruzi with destruction of Meissner’s and Auerbach’s plexuses of the esophagus.
Esophagogram and manometry of the esophagus are fundamental for the diagnosis and allow classification into three stages: incipient, non-advanced, and advanced (end stage).
Non-operative treatment provides only temporary relief of dysphagia.
Cardiomyotomy with partial fundoplication is indicated in the non-advanced variant of achalasia and provides relief of dysphagia.
Motility studies confirm a significant decrease of LES pressure after both types of operation, open or laparoscopic.
The benefits of minimally invasive surgery include reduction of pain, short hospital stay, and more rapid return to normal activities.
Advanced achalasia is treated by transhiatal esophagectomy without thoracotomy and cervical gastroplasty.
The occurrence of Barrett's epithelium in the esophageal stump will prompt annual...
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Selected Readings
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Cecconello, I., Takeda, F.R., Pinotti, H.W. (2009). Achalasia: Chagas' Disease. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_41
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