Esophagectomy for end-stage achalasia

Approximately 5% of patients will require esophageal replacement for end-stage achalasia. This progressive, chronic, and incurable disease is often marked by persistent obstructive symptoms despite treatment, or the development of a dilated, tortuous megaesophagus. The surgical management of patients with end-stage achalasia is challenging given their altered esophageal and mediastinal anatomy, as well as marginal preoperative pulmonary and nutritional reserve. In this brief review, we further describe the indications, preoperative considerations, operative techniques, and outcomes of patients undergoing esophagectomy for end-stage achalasia.