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
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