Supervision

Developed a method of surgical treatment in patients with achalasia cardia II-III stage, which consists of a total demuskulyarizatsii narrowed esophagus, selective proximal vagotomy and the formation of invaginated valve from its own tissues abdominal esophagus and cardia of the stomach. By this technique were operated 39 patients between the ages of 23 to 62 years with achalasia cardia II (6) and III (33) stages. Postoperative complications caused by way of the operation, was not. Period of stay of the patient in bed after surgery averaged 6,5 ± 1,2 days. Observational data in terms of 1.5 months to 5 years after surgery showed a satisfactory outcome of this operation not only in anatomy but also in the functional aspect, which is confirmed by instrumental methods, and study the quality of life of patients with the scale of GIQLI.
Introduction

Achalasia cardia (achalasia brand viagra online cardiac; negative prefix a + chalasis - relaxation; kardia - an inlet of the stomach, the Greek.) - A disease of the esophagus characterized by the disturbance of the reflex opening cardiac opening when swallowing, a violation of motility and progressive decrease in the tone of tubular esophagus. Sometimes to refer to achalasia cardia use the term "kardiospazm" that inaccurate, since in this disease a true spasm of the lower esophageal sphincter does not occur. The disease was first described by Th. Willis in 1674

Achalasia cardia is from 3 to 20% of all diseases of the esophagus and occurs in all age generic viagra groups, but most often it vulnerable men and women aged 20 to 50 years, while surgical treatment is only 10-15% of patients [2-4 , 6, 7].

Typically, the first symptoms are transient signs of dysphagia, and pain behind the breastbone or in the epigastric region after the act of swallowing. Then dysphagia patients becomes permanent. Symptoms of dysphagia increase or decrease depending on the emotional state. In the next stage of the disease symptoms of dysphagia brand name levitra and pain decrease, but there is a new pain - regurgitation, which carries first reflex character, appearing at a height of difficulty swallowing and, later called by the patient.

From the esophagus to the course of the disease and certain changes. The presence of obstacles in the area of the cardia leads to its expansion and elongation. And if in the initial stages of the disease of the esophagus capacity is 150-200 ml, then it increases to 3.2 liters. In addition, the marked elongation and very specific (fusiform, S-shaped, sac-like) deformation of the esophagus [1].

And if in patients with achalasia cardia stage IV the question of radical surgical treatment with subtotal cialis without prescription resection of the esophagus and its one-stage grafting is usually not in doubt [2, 4], for patients with co II-III stage of the disease are generic levitra trying to resort to less severe and traumatic operations. The most common modification of the operation proposed by B. Heller (1913), which was first produced vneslizistuyu ezofagokardiomiotomiyu. The essence of the operation is that of abdominal access mobilize narrowed portion of the esophagus and relegates it to the abdominal cavity. After that, the muscle membrane in the narrowed segment of the esophagus longitudinally dissect the anterior and posterior wall to the mucosa. The operation of Heller provides discrepancy edges dissected muscles of the esophagus, mucosal prolapse and increased narrowing of the esophagus. For efficiency, the full intersection of the circular muscle fibers. The effectiveness of surgery is quite high - good and excellent results are achieved in 79-91% of cases. Lethality, the consolidated data is 0,7-1,5%. Set of recurrence (36-50%) and no effect (9-14%), various complications in the immediate and long-term period after surgery Geller attributed to incomplete dissection of the muscles of the cardia because of the danger to the mucosa of the esophagus. Relapse occurs because of the scar between the edges intersected with the restoration of muscle tone [5].

Often occurs after an operation failure of the cardia with the subsequent development of reflux esophagitis and peptic stricture of the esophagus, Barrett's esophagus and esophageal cancer. Some authors consider reflux esophagitis frequent and serious complication of Heller's operation and found it at 14-37% of patients [5].

Thus far the problem of treating patients with achalasia cardia II-III stage remains relevant and requires further investigation.
Materials and methods

Under our supervision there were 39 patients with achalasia cardia II-III stage (see table), including 16 (41.0%) males and 23 (59,0%) women aged 23 to 62 years (average age 34 1 ± 6,2 years).

Distribution depending on the stage of the disease was carried out based on the classification BV Petrovsky (1962):

Stage I - periodic short-term difficulty in passage of food through the lower sphincter due to violations of the relaxation of the latter and changes in esophageal motility;

Stage II - the food a longer delay due to sustained spasm, which leads to a moderate expansion of the esophagus over the place of the restriction;

Stage III - cicatricial narrowing of the cardiac department with a steady expansion of the higher-lying areas;

Stage IV - pronounced stenosis of the cardia with a dilation of the overlying units, the development of ulcerative necrotizing esophagitis periezofagita and fibrous mediastinitis.

The disease duration ranged from 3 to 25 years (mean 12,4 ± 3,6 years).

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