www.oaepublish.com © The Author(s) 2017 167 Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through Jose Luis Braga De Aquino, Marcelo Manzano Said, José Gonzaga Teixeira De Camargo Department of Surgery, Medical School, Catholic University at Campinas, Campinas, SP 13015-192, Brazil. Correspondence to: Dr. Jose Luis Braga De Aquino, Department of Surgery, Medical School, Catholic University at Campinas, Boaventurado Amaral, 1190, ap. 12-CEP, Campinas, SP 13015-192, Brazil. E-mail: jlaquino@sigmanet.com.br How to cite this article: De Aquino JLB, Said MM, De Camargo JGT. Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through. Mini-invasive Surg 2017;1:167-72. Quick Response Code: Topic: Achalasia Management: the South American viewpoint This is an open access article licensed under the terms of Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the identical terms. For reprints contact: service@oaepublish.com Open Access De Aquino et al. Mini-invasive Surg 2017;1:167-72 DOI: 10.20517/2574-1225.2017.29 Mini-invasive Surgery www.misjournal.net Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications. This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus. Methods: We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation. Results: Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients. Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up. Key words: Achalasia, esophagectomy, megaesophagus, mucosectomy ABSTRACT Article history: Received: 27 Jul 2017 First Decision: 10 Aug 2017 Revised: 1 Oct 2017 Accepted: 14 Oct 2017 Published: 28 Dec 2017 INTRODUCTION Idiopathic and chagasic achalasia have different etiology but, apart from this fact, both diseases share the same clinical, radiologic, endoscopic and manometric presentations. Thus, any therapeutic modality may be applied equality irrespective of etiology. Different approaches have been proposed to treat this disease, such as endoscopic dilatation, esophageal caliber-reducing operations, operations on the diaphragm or esophageal extrinsic innervation, cardiectomy, cardioplasties, transthoracic and transhiatal esophagectomy. Neither treatment; however, seems to be ideal since they do not act directly on the physiopathology of the disease [1-5] .