• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2020 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 Emerging Technology Session Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Courses
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

Treatment of Achalasia with Heller Myotomy After Laparoscopic Gastric Bypass

Katya Ericson, MD, Howard Lederer, MD. Hennepin County Medical Center, Minneapolis, MN

Introduction:

Laparoscopic Heller Myotomy is well described in the literature as a good surgical option for treatment of esophageal achalasia. There have been a number of case reports in the literature describing lap Heller myotomy done simultaneously with or after surgical procedures to treat obesity. We present the first case in the US, and the second in the world literature of a patient who underwent lap gastric bypass and years later was treated with Heller Myotomy.

Methods:

Chart review of single patient as well as a review of publicly available computer database.

Case presentation:

Our patient is a 62yo female who was diagnosed with achalasia in 1995 underwent open Roux-en-Y gastric bypass at an outside institution in 2001. For unknown reasons, her achalasia was not addressed prior to or at the time of her gastric bypass. After the bypass, her dysphagia has worsened. She was treated with botox injection but continued to have dysphagia to both liquids and solids. She was referred to our bariatric surgical team. After reviewing her upper GI that showed markedly dilated esophagus with abrupt short segment distal tapering consistent with achalasia, we offered her lap Heller myotomy and she elected to proceed.

In July, 2010 we performed lap Heller myotomy that involved three 5 mm ports, one 10, 11, 12 mm ports. Our surgery involved tedious dissection of the foregut adhesions. Intraoperative EGD was performed to indentify GE junction both endoscopically and laparoscopically. We then incised the longitudinal and transverse esophageal muscle fibers until bulging mucosa was visualized, 3 cm proximal up esophagus and 2 cm distal to the gastroesophageal junction. Our operative time was 2 hrs and 31 minutes with minimal blood loss. The procedure was completed laparoscopically and patient was discharged home on post operative day #1. At 2 months follow up, she was tolerating regular diet with complete resolution of her dysphagia and no ill effects.

Discussion:

One of the first reports addressing surgical treatment of achalasia in a bariatric patient was published in 2003 by Almogy who described 3 morbid obese patients who also had simultaneous achalasia. Two underwent simultaneous duodenal switch and Heller myotomy. The third patient underwent Heller myotomy after duodenal switch because initial motility study was misinterpreted. Kaufman et al first described lap RNYGB simultaneous with Heller myotomy in 2005. His results were later duplicated by O’Rourke. Then, in 2009 Ramos et al from Brazil described the first case of lap Heller myotomy four years after RNYGB. Cho from Cleveland Clinic in Florida described a patient who developed achalasia after laparoscopic vertical banded gastroplasty and was treated with Heller myotomy with anterior semifundoplication. And the latest report published was in 2010 by Hagen who performed simultaneous sleeve gastrectomy and robotic Heller myotomy. Here, we describe a case of lap Heller myotomy in a patient who underwent open RNYGB 9 years prior to this surgery.

Conclusion:

Laparoscopic Heller myotomy is a good surgical option for treatment of achalasia and should be done simultaneously with morbid obesity surgery.


Session: Poster
Program Number: P094
View Poster

Post Views: 759

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc