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Recurrent achalasia after Heller-Toupet procedure: Laparoscopic extended redo heller myotomy and floppy Dor.

Golash V - J Minim Access Surg (2007)

Bottom Line: These recurrences can be managed by regular dilation failing which a redo surgery is indicated.Laparoscopic approach is now standard because of the obvious benefits for patients and surgeons.Patient is asymptomatic six months after the surgery and radiologically there is free passage of barium in the stomach.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Sultan Qaboos Hospital, P.O. Box: 98, Salalah, 211, Sultanate of Oman.

ABSTRACT
Recurrences of symptoms after the surgery for achalasia cardia are not uncommon. There are several causes of recurrences but the early recurrences are speculated to be secondary to incomplete myotomy and late recurrence due to fibrosis after the myotomy or megaesophagus. These recurrences can be managed by regular dilation failing which a redo surgery is indicated. Laparoscopic approach is now standard because of the obvious benefits for patients and surgeons. Extent of myotomy and addition of fundoplication are debatable issue in the management of achalasia cardia but evidence suggests that some kind of fundoplication would be necessary after the complete division of lower esophageal sphincter. We present our experience in a case of recurrent achalasia, secondary to incomplete myotomy managed laparoscopically by extended myotomy and a floppy anterior fundoplication. Patient is asymptomatic six months after the surgery and radiologically there is free passage of barium in the stomach.

No MeSH data available.


Related in: MedlinePlus

Port position and scar of previous surgery
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Figure 0001: Port position and scar of previous surgery

Mentions: A 60-year-old man presented with the history of progressive dysphagia, regurgitation and an offensive smell of fermented food from his mouth since his surgery for achalasia cardia 32 years ago. The precise details of the surgery were not available. It was also not known whether an anti-reflux procedure was done at the previous surgery although a recent CT scan had shown a partial wrap. He claims that his dysphagia and regurgitation were immediately improved after his first operation. But after a year or so he started having dysphagia again which got progressively worse over the years. On examination, his general health was satisfactory. The previous Heller was done by open transabdominal approach and he had an upper midline laparotomy scar [Figure 1A]. His routine work-up revealed the following findings:


Recurrent achalasia after Heller-Toupet procedure: Laparoscopic extended redo heller myotomy and floppy Dor.

Golash V - J Minim Access Surg (2007)

Port position and scar of previous surgery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749184&req=5

Figure 0001: Port position and scar of previous surgery
Mentions: A 60-year-old man presented with the history of progressive dysphagia, regurgitation and an offensive smell of fermented food from his mouth since his surgery for achalasia cardia 32 years ago. The precise details of the surgery were not available. It was also not known whether an anti-reflux procedure was done at the previous surgery although a recent CT scan had shown a partial wrap. He claims that his dysphagia and regurgitation were immediately improved after his first operation. But after a year or so he started having dysphagia again which got progressively worse over the years. On examination, his general health was satisfactory. The previous Heller was done by open transabdominal approach and he had an upper midline laparotomy scar [Figure 1A]. His routine work-up revealed the following findings:

Bottom Line: These recurrences can be managed by regular dilation failing which a redo surgery is indicated.Laparoscopic approach is now standard because of the obvious benefits for patients and surgeons.Patient is asymptomatic six months after the surgery and radiologically there is free passage of barium in the stomach.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Sultan Qaboos Hospital, P.O. Box: 98, Salalah, 211, Sultanate of Oman.

ABSTRACT
Recurrences of symptoms after the surgery for achalasia cardia are not uncommon. There are several causes of recurrences but the early recurrences are speculated to be secondary to incomplete myotomy and late recurrence due to fibrosis after the myotomy or megaesophagus. These recurrences can be managed by regular dilation failing which a redo surgery is indicated. Laparoscopic approach is now standard because of the obvious benefits for patients and surgeons. Extent of myotomy and addition of fundoplication are debatable issue in the management of achalasia cardia but evidence suggests that some kind of fundoplication would be necessary after the complete division of lower esophageal sphincter. We present our experience in a case of recurrent achalasia, secondary to incomplete myotomy managed laparoscopically by extended myotomy and a floppy anterior fundoplication. Patient is asymptomatic six months after the surgery and radiologically there is free passage of barium in the stomach.

No MeSH data available.


Related in: MedlinePlus