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Laparoscopic Heller myotomy after Roux-en-Y gastric bypass

  • Alberto AiolfiEmail author
  • Stefania Tornese
  • Lavinia Barbieri
  • Valerio Panizzo
  • Giancarlo Micheletto
  • Davide Bona
case report

Summary

Background

Achalasia is a rare motility disorder of the esophagus and laparoscopic Heller myotomy (LHM) is the standard of care for symptom relief. The onset of achalasia in obese patients after Roux-en-Y gastric bypass (RYGB) is rare, the diagnosis is difficult, and the treatment is challenging.

Methods

We reviewed the hospital charts of a patient presenting with achalasia after RYGB. A review of the pertinent literature was performed.

Results

A 51-year-old female was admitted to our department for a 10-month history of progressive dysphagia, regurgitation, and weight loss. She previously underwent laparoscopic RYGB for morbid obesity. The upper gastrointestinal endoscopy showed a dilated esophagus with increased resistance at the gastroesophageal junction. The barium swallow study revealed the classical “mouse-tail” appearance of the esophagogastric junction with delayed esophageal emptying. High-resolution manometry (HRM) was suggestive of a type II achalasia with esophageal body pan-pressurization. The patient underwent LHM. The overall operative time was 95 min and intraoperative blood loss was negligible. The postoperative course was uneventful and the patient was discharged on postoperative day 2. At 24-month follow-up, the patient has complete remission of symptoms.

Conclusion

Development of achalasia in obese patients after RYGB is rare. The presence of pathognomonic symptoms should always raise clinical suspicion, while HRM is essential to confirm the diagnosis. To date, there is no robust evidence for the more appropriate treatment of esophageal achalasia after RYGB. In these patients, LHM seems feasible, safe, and effective in symptom relief.

Keywords

Esophageal achalasia Roux-en-Y gastric bypass Laparoscopic Heller myotomy Peroral Endoscopic Myotomy (POEM) Dysphagia 

Notes

Compliance with ethical guidelines

Conflict of interest

A. Aiolfi, S. Tornese, L. Barbieri, V. Panizzo, G. Micheletto, and D. Bona declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant’AmbrogioUniversity of MilanMilanItaly
  2. 2.Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant’AmbrogioUniversity of MilanMilanItaly
  3. 3.MilanItaly

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