Nasogastric tube after laparoscopic Heller-Dor surgery: Do you really need it?

Achalasia is a rare disorder of esophageal motility, characterized by absent or impaired peri- stalsis and incomplete relaxation of the lower esophageal sphincter (LES).1 This disease is char- acterized by a partial or total impairment of non-cholinergic inhibitory nerves of the Auerbach plexus.1 The etiology is unclear but there are multifactorial causes such as autoimmune, infec- tive, neurodegenerative and, genetics factors.2-4 Although not specific, dysphagia for solids and liquids, regurgitation, weight loss and chest pain represent the most common symptoms, while less frequently patients can complain of noc- turnal cough, heartburn, and pulmonary aspiration.5-8 The Eckardt score is the grading system used to evaluate the severity of symptoms and es- tablish the efficacy of treatment. The score assigns to each of the cardinal symptoms (dysphagia, regurgitation, chest pain and weight loss) a value ranging from zero to 3 points according to the reported severity and frequency. A score of 0-1 corresponds to clinical stage 0; 2-3 to stage I; 4-6 to stage II and a score > 6 to stage III.5,8,9 The gold standard for diagnosis is High resolution manometry (HRM). According to the Chicago classification, there are three subtypes of Achalasia: type I with absent or minimal con- tractility of esophageal, type II with panesophageal pressurization and type III with spastic con- tractions.