Laparoscopic re-do myotomy in a patient with previous insufficient myotomy

Rudolf Baron Buxhoeveden, Manuel Maya, Florencia Ocariz, Pablo Luna, Gustavo Bugari. Hospital Aleman de Buenos Aires

Introduction: Achalasia of the esophagus is a primary esophageal motility disorder of uncertain etiology. Aperistalsis of the esophagus and lack of relaxation of the lower esophageal sphincter in response to swallow are characteristic of this disease. Esophageal manometry is the diagnostic test and the gold standard treatment is the esophageal myotomy. An extended myotomy is mandatory to achieve relief of the dysphagia.

Description of contents: 15-year-old man who presented to another institution complaining of dysphagia for 1 year. He was diagnosed with achalasia. According to the diagnosis, the patient underwent an open esophageal myotomy with Toupet fundoplication. After the operation, he complained of persistent dysphagia, weight loss and chest pain. The patient was referred to our clinic 1 year after his surgery. A new upper GI demonstrated an increased esophageal dilatation. A small diverticulum at the GE junction could also be observed. Decision was made to performed a laparoscopic re-do esophageal myotomy. The patient recovered without complications, reporting complete resolution of symptoms.

Comments and/or observations: esophageal myotomy is the gold standard treatment for esophageal achalasia. The myotomy should be extensive in length, to attain relief of symptoms.

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