Case report

Laparoscopic Heller myotomy after previous Roux-en-Y gastric bypass

Case presentation and management

We present a 46-year-old female who previously underwent a laparoscopic Roux-en-Y gastric bypass in 2011 at an outside hospital. She presented with chronic cough and regurgitation 4 years postoperatively. Her body mass index on presentation was 34.3 kg/m².

An upper gastrointestinal series (UGI) or swallow study was performed, which showed a dilated esophagus with a distal narrowing or “bird’s beak” appearance at the gastroesophageal junction with delayed emptying into the gastric pouch. Upper

Discussion

Achalasia is a rare entity among the obese population. It is infrequently recognized in bariatric patients who present with atypical symptoms. Our video demonstrates a laparoscopic Heller myotomy with a modified Dor fundoplication after previous laparoscopic Roux-en-Y gastric bypass.

Data on achalasia after bariatric surgery have been limited in the literature to date [2], [4], [5], [6], [7]. Bariatric surgery performed concurrently with Heller myotomy is also a viable option and has been

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.