grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2020-179-5-41-46grekov-1592Research ArticleЭНДОСКОПИЯ И ВНУТРИПРОСВЕТНАЯ ХИРУРГИЯENDOSCOPY AND ENDOLUMINAL SURGERYЭндоскопическое лечение сохраняющейся дисфагии после операции геллера у больной со спастическим вариантом ахалазии кардии с использованием интраоперационной манометрии высокого разрешенияEndoscopic treatment for persistent dysphagia after heller myotomy in a patient with spastic type of achalasia with the use of the intraoperative high-resolution manometryhttps://orcid.org/0000-0002-6440-2370СмирновА. А.SmirnovA. A.

кандидат медицинских наук, доцент кафедры госпитальной хирургии № 2, руководитель отдела эндоскопии НИИ хирургии и неотложной медицины, 

Санкт-Петербург

Cand. of Sci. (Med.), Associate Professor of the Department of Hospital Surgery No. 2, Head of the Endoscopy Department of the Research Institute of Surgery and Emergency Medicine,

Saint Petersburg

smirnov-1959@yandex.ruhttps://orcid.org/0000-0001-6623-5601КонкинаН. В.KonkinaN. V.

врач-эндоскопист, 

Санкт-Петербург

Endoscopist,

Saint Petersburg

n_konkina@inbox.ruhttps://orcid.org/0000-0003-3821-3805КирильцеваМ. М.KiriltsevaM. M.

врач-эндоскопист, 

Санкт-Петербург

Endoscopist,

Saint Petersburg

kiriltseva@mail.ruhttps://orcid.org/0000-0003-1110-1379ЛюбченкоМ. Е.LyubchenkoM. E.

врач-эндоскопист, 

Санкт-Петербург

Endoscopist,

Saint Petersburg

mashulka.87@mail.ruhttps://orcid.org/0000-0002-3100-1917ДавлетбаеваЛ. И.DavletbaevaL. I.

врач-эндоскопист, 

Санкт-Петербург

Endoscopist,

Saint Petersburg

davletbaeva-leysan-i@yandex.ruhttps://orcid.org/0000-0001-7283-079XВасилевскийД. И.VasilevskiyD. I.

доктор медицинских наук, доцент кафедры факультетской хирургии,

Санкт-Петербург

Dr. of Sci. (Med.), Associate Professor of the Department of Faculty Surgery, 

Saint Petersburg

vasilevsky1969@gmail.comhttps://orcid.org/0000-0001-7449-6908КорольковА. Ю.KorolkovA. Yu.

доктор медицинских наук, доцент кафедры хирургии госпитальной с клиникой, руководитель отдела общей и неотложной хирургии НИИ хирургии и неотложной медицины, 

Санкт-Петербург

Dr. of Sci. (Med.), Associate Professor of the Department of Hospital Surgery with Clinic, Head of the Department of General and Emergency Surgery of the Research Institute of Surgery and Emergency Medicine, 

Saint Petersburg

korolkov.a@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииPavlov University20203007202017954146Copyright © Смирнов А.А., Конкина Н.В., Кирильцева М.М., Любченко М.Е., Давлетбаева Л.И., Василевский Д.И., Корольков А.Ю., 20212021Смирнов А.А., Конкина Н.В., Кирильцева М.М., Любченко М.Е., Давлетбаева Л.И., Василевский Д.И., Корольков А.Ю.Smirnov A.A., Konkina N.V., Kiriltseva M.M., Lyubchenko M.E., Davletbaeva L.I., Vasilevskiy D.I., Korolkov A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/1592

Пациентке, страдающей ахалазией кардии, с сохраняющейся дисфагией после многократных оперативных вмешательств (операция Геллера с фундопликацией по Тупе, релапаротомия, гастростомия, реконструкция фундопликационной манжеты, видеоторакоскопия слева, вскрытие и дренирование абсцесса) была выполнена пероральная эндоскопическая миотомия. Для выявления причин дисфагии и с целью объективного контроля радикальности операции интраоперационно была использована манометрия пищевода высокого разрешения, что поспособствовало успешному эндоскопическому лечению и возвращению пациентки к приему пищи через рот. 

A Peroral Endoscopic Myotomy was performed on the patient with the persistent dysphagia despite preceding Heller myotomy combined with partial fundoplication, relaparotomy, fundoplication wrap reconstruction, gastrostomy and left-sided thoracoscopy with the drainage of the thoracic abscess. The use of intraoperative High-Resolution Manometry during Endoscopic Peroral Myotomy helped to reveal the reasons for the failure of previous treatment and to address the dysphagia.

ахалазияпероральная эндоскопическая миотомиядисфагияманометрия высокого разрешенияachalasiaperoral endoscopic myotomydysphagiahigh-resolution manometryReferencesIdiopathic (primary) аchalasia : а review Rare gastrointestinal diseases/ D. A. Patel, H. P. Kim, J. S. Zifodya, M. F. Vaezi // Orphanet Journal of Rare Diseases. 2015. Vol. 10, № 1. Doi: 10.1186/s13023-015-0302-1.Patel D. A., Kim H. P., Zifodya J. S., Vaezi M. F. Idiopathic (primary) Achalasia: A review Rare gastrointestinal diseases. Orphanet Journal of Rare Diseases. 2015;10(1). Doi: 10.1186/s13023-015-0302-1.Kahrilas P. J., Ghosh S. K., Pandolfino J. E. Esophageal motility disorders in terms of pressure topography : The Chicago classification // Journal of Clinical Gastroenterology. 2008. Vol. 42. Р. 627–635. Doi: 10.1097/ MCG.0b013e31815ea291.Kahrilas P. J., Ghosh S. K., Pandolfino J. E. Esophageal motility disorders in terms of pressure topography: The Chicago classification. Journal of Clinical Gastroenterology. 2008;42:627–635. Doi: 10.1097/MCG.0b013e31815ea291.Mirsharifi A., Abdehgah A. G., Mirsharifi R. et al. Laparoscopic heller myotomy for Achalasia : Experience from a single referral tertiary center // Middle East Journal of Digestive Diseases. 2019. Vol. 11, № 2. Р. 90–97. Doi: 10.15171/mejdd.2018.133.Mirsharifi A., Abdehgah A. G., Mirsharifi R., Jafari M., Fattah N., Mikaeli J., Soroush A. R. Laparoscopic heller myotomy for Achalasia: Experience from a single referral tertiary center. Middle East Journal of Digestive Diseases. 2019;11(2):90–97. Doi: 10.15171/mejdd.2018.133.Tsuboi K., Omura N., Yano F. et al. Data analyses and perspectives on laparoscopic surgery for esophageal Achalasia // World Journal of Gastroenterology. 2015. Doi: 10.3748/wjg.v21.i38.10830.Tsuboi K., Omura N., Yano F., Hoshino M., Yamamoto S., Akimoto S., Masuda T., Kashiwagi H., Yanaga K. Data analyses and perspectives on laparoscopic surgery for esophageal Achalasia. World Journal of Gastroenterology. 2015. Doi: 10.3748/wjg.v21.i38.10830.Andolfi C., Fisichella P. M. Meta-analysis of clinical outcome after treatment for achalasia based on manometric subtypes // British Journal of Surgery. 2019. Doi: 10.1002/bjs.11049.Andolfi C., Fisichella P. M. Meta-analysis of clinical outcome after treatment for achalasia based on manometric subtypes. British Journal of Surgery. 2019. Doi: 10.1002/bjs.11049.Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia / E. D. Kane, V. Budhraja, D. J. Desilets, J. R. Romanelli // Surgical Endoscopy. 2019. Vol. 33, № 3. Р. 886–894. Doi: 10.1007/s00464-018-6356-0.Kane E. D., Budhraja V., Desilets D. J., Romanelli J. R. Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia. Surgical Endoscopy. 2019;33(3):886–894. Doi: 10.1007/ s00464-018-6356-0.Kumbhari V., Tieu A., Onimaru M. et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients : a multicenter comparative study // Endoscopy International Open. 2015. Vol. 3, № 03. Р. E195–E201. Doi: 10.1055/s-0034-1391668.Kumbhari V., Tieu A., Onimaru M., El Zein M., Teitelbaum E., Ujiki M., Gitelis M., Modayil R., Hungness E., Stavropoulos S., Shiwaku H., Kunda R., Chiu P., Saxena P., Messallam A., Inoue H., Khashab M. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endoscopy International Open. 2015;3(03):E195– E201. Doi: 10.1055/s-0034-1391668.Patti M. G., Allaix M. E. Recurrent symptoms after Heller myotomy for achalasia : Evaluation and treatment // World Journal of Surgery. 2015. Vol. 39. Р. 1625–1630. Doi: 10.1007/s00268-014-2901-8.Patti M. G., Allaix M. E. Recurrent symptoms after Heller myotomy for achalasia: Evaluation and treatment. World Journal of Surgery. 2015; 39:1625–1630. Doi: 10.1007/s00268-014-2901-8.Smith K. E., Saad A. R., Hanna J. P. et al. Revisional Surgery in Patients with Recurrent Dysphagia after Heller Myotomy // Journal of Gastrointestinal Surgery. 2019. Doi: 10.1007/s11605-019-04264-3.Smith K. E., Saad A. R., Hanna J. P., Tran T., Jacobs J., Richter J. E., Velanovich V. Revisional Surgery in Patients with Recurrent Dysphagia after Heller Myotomy. Journal of Gastrointestinal Surgery. 2019. Doi: 10.1007/s11605-019-04264-3.Inoue H., Minami H., Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia // Endoscopy. 2010. Vol. 42, № 4. Р. 265–271. Doi: 10.1055/s-0029-1244080.Inoue H., Minami H., Kobayashi Y., Sato Y., Kaga M., Suzuki M., Satodate H., Odaka N., Itoh H., Kudo S. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4),265–271. Doi: 10.1055/s-0029-1244080.Shiwaku H., Inoue H., Onimaru M. et al. Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia : analysis of data from more than 1300 patients at eight facilities in Japan // Surgical Endoscopy. 2020. Vol. 34, № 1. Р. 464–468. Doi: 10.1007/s00464-019-06833-8.Shiwaku H., Inoue H., Onimaru M., Minami H., Sato H., Sato C., Tanaka S., Ogawa R., Okushima N. Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan. Surgical Endoscopy. 2020;34(1),464–468. Doi: 10.1007/s00464-019-06833-8.Triantafyllou T., Doulami G., Papailiou J. et al. Real-time Continuous Esophageal High-resolution Manometry (HRM) During Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Achalasia. A Promising Novelty in Regards of Perfecting Surgical Technique : Could It Guide Surgical Technique Toward Excellent Results? // Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2016. Vol. 26, № 6. Р. e163–e166. Doi: 10.1097/SLE.0000000000000336.Triantafyllou T., Doulami G., Papailiou J., Mantides A., Zografos G., Theodorou D. Real-time Continuous Esophageal High-resolution Manometry (HRM) During Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Achalasia. A Promising Novelty in Regards of Perfecting Surgical Technique: Could It Guide Surgical Technique Toward Excellent Results? Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2016;26(6),e163–e166. Doi: 10.1097/SLE.0000000000000336.Yu Y. R., Rosenfeld E. H., Chiou E. H. et al. High-resolution manometric guidance during laparoscopic Heller myotomy : Impact on quality of life and symptom severity for children with achalasia // Journal of Pediatric Surgery. 2019. Vol. 54, № 5. Р. 1063–1068. Doi: 10.1016/j.jpedsurg.2019.01.041.Yu Y. R., Rosenfeld E. H., Chiou E. H., Chumpitazi B. P., Fallon S. C., Brandt M. L. High-resolution manometric guidance during laparoscopic Heller myotomy: Impact on quality of life and symptom severity for children with achalasia. Journal of Pediatric Surgery. 2019;54(5):1063–1068. Doi: 10.1016/j.jpedsurg.2019.01.041.Weche M., Saad A. R., Richter J. E. et al. Revisional Procedures for Recurrent Symptoms After Heller Myotomy and Per-Oral Endoscopic Myotomy // Journal of Laparoendoscopic & Advanced Surgical Techniques. 2019. Doi: 10.1089/lap.2019.0277.Weche M., Saad A. R., Richter J. E., Jacobs J. J., Velanovich V. Revisional Procedures for Recurrent Symptoms After Heller Myotomy and Per-Oral Endoscopic Myotomy. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2019. Doi: 10.1089/lap.2019.0277.Kristensen H., Kirkegård J., Kjær D. W. et al. Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy // Surgical Endoscopy. 2017. Vol. 31, № 6. Р. 2596–2601. Doi: 10.1007/s00464-016-5267-1.Kristensen H., Kirkegård J., Kjær D. W., Mortensen F. V., Kunda R., Bjerregaard N. C. Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy. Surgical Endoscopy. 2017;31(6):2596–2601. Doi: 10.1007/s00464-016-5267-1.Ngamruengphong S., Inoue H., Ujiki M. B. et al. Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy // Clinical Gastroenterology and Hepatology. 2017. Vol. 15, № 10. Р. 1531–1537.e3. Doi: 10.1016/j.cgh.2017.01.031.Ngamruengphong S., Inoue H., Ujiki M. B., Patel L. Y., Bapaye A., Desai P. N., Dorwat S., Nakamura J., Hata Y., Balassone V., Onimaru M., Ponchon T., Pioche M., Roman S., Rivory J., Mion F., Garros A., Draganov P., Perbtani Y., Abbas A., Pannu D., Yang D., Perretta S., Romanelli J., Desilets D., Hayee B., Haji A., Hajiyeva G., Ismail A., Chen Y., Bukhari M., Haito-Chavez Y., Kumbhari V., Saxena P., Talbot M., Chiu P., Yip H., Wong V., Hernaez R., Maselli R., R., Repici A., Khashab M. A. Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy. Clinical Gastroenterology and Hepatology. 2017;15(10):1531–1537.e3. Doi: 10.1016/j.cgh.2017.01.031.

The authors declare that there are no conflicts of interest present.