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Erschienen in: European Surgery 4/2019

13.02.2019 | case report

Laparoscopic Heller myotomy after Roux-en-Y gastric bypass

verfasst von: MD Alberto Aiolfi, MD Stefania Tornese, MD Lavinia Barbieri, MD Valerio Panizzo, MD Giancarlo Micheletto, MD Davide Bona

Erschienen in: European Surgery | Ausgabe 4/2019

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Summary

Background

Achalasia is a rare motility disorder of the esophagus and laparoscopic Heller myotomy (LHM) is the standard of care for symptom relief. The onset of achalasia in obese patients after Roux-en-Y gastric bypass (RYGB) is rare, the diagnosis is difficult, and the treatment is challenging.

Methods

We reviewed the hospital charts of a patient presenting with achalasia after RYGB. A review of the pertinent literature was performed.

Results

A 51-year-old female was admitted to our department for a 10-month history of progressive dysphagia, regurgitation, and weight loss. She previously underwent laparoscopic RYGB for morbid obesity. The upper gastrointestinal endoscopy showed a dilated esophagus with increased resistance at the gastroesophageal junction. The barium swallow study revealed the classical “mouse-tail” appearance of the esophagogastric junction with delayed esophageal emptying. High-resolution manometry (HRM) was suggestive of a type II achalasia with esophageal body pan-pressurization. The patient underwent LHM. The overall operative time was 95 min and intraoperative blood loss was negligible. The postoperative course was uneventful and the patient was discharged on postoperative day 2. At 24-month follow-up, the patient has complete remission of symptoms.

Conclusion

Development of achalasia in obese patients after RYGB is rare. The presence of pathognomonic symptoms should always raise clinical suspicion, while HRM is essential to confirm the diagnosis. To date, there is no robust evidence for the more appropriate treatment of esophageal achalasia after RYGB. In these patients, LHM seems feasible, safe, and effective in symptom relief.
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Metadaten
Titel
Laparoscopic Heller myotomy after Roux-en-Y gastric bypass
verfasst von
MD Alberto Aiolfi
MD Stefania Tornese
MD Lavinia Barbieri
MD Valerio Panizzo
MD Giancarlo Micheletto
MD Davide Bona
Publikationsdatum
13.02.2019
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2019
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-019-0571-3