Surgical treatment of advanced megaesophagus: A systematic review and meta-analysis

Abstract

Introduction: Advanced megaesophagus predisposes to clinical risks of malnutrition, infections, and cancer, in addition to having a significant impact on quality of life. There is currently no consensus in the literature regarding the best surgical option for advanced megaesophagus, although there is a predilection on esophagectomy surgery, which is associated with significant morbidity and mortality. Other surgical procedures, such as esophageal mucosectomy and Heller cardiomyotomy, have been proposed with good results. Aim: To conduct a systematic review and meta-analysis of the literature on the surgical treatment of advanced megaesophagus. Methods: Databases used included PubMed, Lilacs, Embase and MedLine, as well as reference research. Two reviewers chose the articles independently. Results: In total, 14 articles were chosen, with 1,862 patients included. The studies were divided into two groups: laparoscopic cardiomyotomy with fundoplication (213 patients) and major surgeries (1,649 patients). Comparative analyses were performed between variables found on the studies. A comparative analysis between morbidity/complications and mortality versus late outcomes considered good or excellent for both groups was performed for the meta-analysis. Discussion: The studies indicate that both groups had similar results regarding late outcomes, which was considered mostly good or excellent. However, there was significant morbidity associated with the major surgeries group. The cardiomyotomy group had a significantly lower number of patients evaluated and a shorter time of follow-up. Conclusion: Laparoscopic Heller myotomy can be performed on patients with advanced megaesophagus, with lower rates of complications and mortality compared to major surgeries, with reservations to the late outcomes results.

DOI:https://doi.org/10.56238/sevened2023.007-088