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You are here: Home / Abstracts / Recurrent Hiatal Hernia with Dysphagia s/p Heller Myotomy with Dor Fundoplication

Recurrent Hiatal Hernia with Dysphagia s/p Heller Myotomy with Dor Fundoplication

Robert Polak, MD, Theophilus Pham, BA, MBA, Adel Alhaj Saleh, MD, MRCS, Amir H Aryaie, MD, FACS. Texas Tech University, Health Sciences Center

  • 48 y.o. female presented as a referral for possible achalasia  s/p Heller Myotomy and DorFundoplication in 2001.
  • Initially helped for 3 years
  • Has since undergone 10+ endoscopic esophageal dilations

Symptoms:

  • difficulty eating/swallowing, early satiety, food regurgitation, chest pain, choking sensation at night

PMH: 

  • DM, Achalasia, Hypothyroidism, Fibromyalgia, and frequent headaches

PSH: 

  • Heller Myotomy with DorFundoplication, Cholecystectomy, Hysterectomy, Partial Thyroidectomy
  • Patient scheduled for EGD, Manometry, and UGI contrast study

UGI Findings:

  • Stenosis or achalasia at the GE Junction
  • Markedly dilated esophagus

EGD Findings:

  • Easy passage of scope through LES into the stomach
  • Markedly dilated esophagus, LES open, sliding hiatal hernia gastritis
  • Symptoms likely related to hiatal hernia
  • Integrated Relaxing Pressure < 15
  • Frequent failed peristalsis
  • Based on diagnostic workup patient offered a laparoscopic hiatal hernia revision and fundoplication takedown

Patient taken to OR and underwent:

  • Laparoscopic Hiatal Hernia Revision
  • DorFundoplication Takedown
  • Intraoperative EGD
  • Gastropexy
  • Patient doing well postoperatively
  • Symptoms are much improved
  • Able to tolerate PO diet without issue

Conclusion:

  • Dysphagia s/p Heller Myotomy needs to be thoroughly worked up including:
  • EGD, UGI, and manometry
  • Hiatal Hernia repair can significantly improve symptoms of dysphagia 2/2 esophageal dysmotility seen in patients with prior achalasia  
  • Laparoscopic Hiatal Hernia Repair s/p prior Hiatal hernia repair with DorFundoplication is feasible

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 91792

Program Number: V392

Presentation Session: Video Loop Day 4

Presentation Type: VideoLoop

389

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