Julietta Chang, MD1, Ivy N Haskins, MD2, Arielle J Perez, MD3, Ajita S Prabhu, MD4, David M Krpata, MD4, Michael J Rosen, MD4. 1Massachusetts General Hospital, 2George Washington University, 3University of North Carolina, 4Cleveland Clinic Foundation
Achalasia is a rare disease characterized by aperistalsis of the esophagus and incomplete relaxation of the lower esophageal sphincter due to a neurodegenerative disease with loss of inhibitory signals. Pseudoachalasia is a rare secondary of achalasia with similar manometric findings. It can be due to malignant obstruction at the gastroesophageal junction, or due to malignant infiltration of the myenteric plexus. There are now increasing reports of pseudoachalasia secondary to obstruction after foregut surgery such as fundoplication or bariatric procedures, in which the pressure at or just distal to the gastroesophageal junction results in dysphagia and progressive esophageal dysmotility. There are rare reports of performing Heller myotomy for secondary achalasia after relieving the surgical cause of obstruction in order to release any hypertrophied and fibrosed tissue at the lower esophageal sphincter and alleviate dysphagia. We present a 78 year old female with persistent dysphagia after multiple foregut procedures and manometric findings of pseudoachalasia. She was taken to the operating room where was successfully underwent a laparoscopic takedown of her prior fundoplication, with a Heller myotomy, hiatal hernia repair, and gastropexy. Our video also demonstrates that with meticulous dissection, a laparoscopic approach is feasible in a patient with multiple prior operations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87103
Program Number: V101
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo