• O. М. Babii
  • B. F. Shevchenko
  • N. V. Prolom
  • A. A. Galinskij
Keywords: achalasia of cardia, diagnostics, balloon pneumatic dilation, Heller laparoscopic myotomy, relapses.


Summary. Aim. The aim of the work is to evaluate the effectiveness of the minimally invasive technique in the treatment of patients with achalasia of cardia.

Materials and methods. In the Department of Surgery of the digestive organs of the Institute from February 2017 to December 2019, comprehensive treatment was examined and carried out using balloon pneumatic dilatation (PD) and Heller laparoscopic myotomy (LMH) in 21 patients with achalasia cardia. Including Men 8 (38.1 %), women 13 (61.9 %) at the age of 28 to 75 years ((51.47 ± 3.63) years).

Results and discussion. Using radiation methods for examining the diameter of the esophagus, patients were divided into 4 stages: stage I with an esophagus diameter of up to 4 cm — 5 (23.8 %), stage II — 4–6 cm — 6 (28.6 %), III — 6–8 cm — 5 (23.8 %), IV — more than 8 cm with an S-shaped curved configuration — 5 (23.8 %) patients. The duration of the disease is from one month to 8 years, on average (3.05 ± 0.49) years. The symptomatic treatment efficacy after PD according to the Eckardt scale was 66.7-76.2 %, while after LMH it was 80.0%. The level of relaxation efficiency of the lower esophagus according to manometry was achieved in 81 % of cases. The effectiveness of a barium esophagogram in changing the height of a barium column after a bolus was successful in 76.2-85.7 % of cases. There were no complications when performing balloon PD and LMH.

Conclusions. Relapses of achalasia of cardia after balloon PD were established in the period from 2 to 10 months in 33.3 % of cases: 4.7 % in stage I and 9.5 % of cases in stages II, III, IV. With AK relapses in 5 (23.8 %) cases, repeated use of dilatation was ineffective. Performed by LMH and fundoplication Door. The efficiency of balloon PD was 66.7 % after the initial course and 76.2 % after the second course, and the LMH efficiency after the failed PD was 80.0 %.


1. Amani M., Fazlollahi N., Shirani S., Malekzadeh R., & Mikaeli J. (2016). Assessment of pneumatic balloon dilation in patients with symptomatic relapse after failed Heller myotomy: A single center experience. Middle East journal of digestive diseases, 8(1), 57-62. doi:doi: 10.15171/mejdd.2016.08
2. Boeckxstaens G. E., Annese V., Bruley des Varannes S., Chaussade S., Costantini M., Cuttitta A., Busch O. R. (2011). Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. New England Journal of Medicine, 364(19), 1807-1816.
3. Boeckxstaens G. E., Annese V., Varannes S., Chaussa-de S., Costantini M., Cuttitta A., & Smout A. J. (2011). Pneumatic Dilation versus Laparoscopic Heller’s Myotomy for Idiopathic. New England Journal of Medicine, 364(19), 1807-1816.
4. Cheng J. V., Yin L., Xing W. Q., Lv H. W., & Wang H. R. (2017). Laparoscopic Heller myotomy is not superior to pneumatic dilation in the management of primary achalasia. Medicine, 96(7), e5525. doi:
5. Chrystoja C. C., Darling G. E., Diamant N. E., Kortan P. P., Tomlinson G. A., Deitel W., . . . Urbach D. (2016). Achalasia-Specific Quality of Life After Pneumatic Dilation or Laparoscopic Heller Myotomy With Partial Fundoplication: A Multicenter, Randomized Clinical Trial. American Journal of Gastroenterology, 111(11), 1536-1545. doi:doi: 10.1038/ajg.2016.402
6. Clark S. B., Rice T. W., Tubbs R. R., Richter J. E., & Goldblum J. R. (2000). The nature of the myenteric infiltrate in achalasia: an immunohistochemical analysis. 24(8), 1153-1158. Получено из
7. Enestvedt B. K., Williams J. L., & Sonnenberg A. (2011). Epidemiology and practice patterns of achalasia in a large multi‐centre database. Alimentary pharmacology & therapeutics, 33(11), 1209-1214. doi:
8. Illés A., Borbásné Farkas K., Hegyi P., Garami A., Szabó I., Solymár M., . . . Vincze A. (2017). Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis. Journal of Gastrointestinal and Liver Diseases, 26(2), 121-127. doi: 10.15403/jgld.2014.1121.262.myo
9. Moonen A., Annese A., Belmans A., Bredenoord A. J., Des Varannes S. B., Costantini M., Boeckxstaens G. E. (2016). Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut, 65(5), 732-739. doi:
10. Saleh C., Ponds F., Schijven M. P., Smout A., & Bredenoord A. (2016). Efficacy of pneumodilation in achalasia after failed Heller myotomy. Neurogastroenterology & Motility, 28(11), 1741-1746. doi:
11. Salis G. B., Mazzadi S. A., Garcia A. O., & Chiocca J. C. (2004). Pneumatic dilatation in achalasia of the esophagus: a report from Argentina. Diseases of the Esophagus, 17(2), 124-128. doi:
How to Cite
BabiiO. М., Shevchenko, B. F., Prolom, N. V., & Galinskij, A. A. (2020). MINIMALLY INVASIVE TREATMENT FOR ACHALASIA OF CARDIA. Kharkiv Surgical School, (1), 27-36.