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Achalasia 5 years following Roux-en-y gastric bypass.

Torghabeh MH, Afaneh C, Saif T, Dakin GF - J Minim Access Surg (2015 Jul-Sep)

Bottom Line: Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited.This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food.The role of performing a fundoplication in these patients remains to be elucidated.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA.

ABSTRACT
Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited. This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food. The following case describes achalasia in a patient 5 years following a laparoscopic Roux-en-Y gastric bypass (RYGB). The patient underwent a laparoscopic Heller myotomy without a fundoplication. Although achalasia seems to be a rare occurrence in obese patients, this is the third case documented in a patient who previously had an RYGB. The role of performing a fundoplication in these patients remains to be elucidated.

No MeSH data available.


Related in: MedlinePlus

The upper gastrointestinal series at post-operative day 1 illustrates free passage of contrast into the gastric pouch
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Figure 1: The upper gastrointestinal series at post-operative day 1 illustrates free passage of contrast into the gastric pouch

Mentions: The patient was scheduled for laparoscopic oesophageal myotomy. The distal oesophagus was carefully dissected into the chest. Adhesions to the gastric pouch were released. A myotomy beginning 1 cm distal to the gastroesophageal junction (GEJ) on the gastric pouch was performed, extending 7 cm cephalad onto the distal oesophagus using electrocautery. Intra-operative endoscopy was performed to ensure complete disruption of the circular muscle layer without evidence of narrowing. An anti-reflux procedure was not performed. Routine UGI was performed on post-operative day 1 [Figure 1] illustrating free passage of contrast into the gastric pouch without evidence of the leak or delayed transit. Four months later, the patient continued to tolerate solids without difficulty or regurgitation. Moreover, the patient had no symptoms of GERD at that time and remained medication-free.


Achalasia 5 years following Roux-en-y gastric bypass.

Torghabeh MH, Afaneh C, Saif T, Dakin GF - J Minim Access Surg (2015 Jul-Sep)

The upper gastrointestinal series at post-operative day 1 illustrates free passage of contrast into the gastric pouch
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499927&req=5

Figure 1: The upper gastrointestinal series at post-operative day 1 illustrates free passage of contrast into the gastric pouch
Mentions: The patient was scheduled for laparoscopic oesophageal myotomy. The distal oesophagus was carefully dissected into the chest. Adhesions to the gastric pouch were released. A myotomy beginning 1 cm distal to the gastroesophageal junction (GEJ) on the gastric pouch was performed, extending 7 cm cephalad onto the distal oesophagus using electrocautery. Intra-operative endoscopy was performed to ensure complete disruption of the circular muscle layer without evidence of narrowing. An anti-reflux procedure was not performed. Routine UGI was performed on post-operative day 1 [Figure 1] illustrating free passage of contrast into the gastric pouch without evidence of the leak or delayed transit. Four months later, the patient continued to tolerate solids without difficulty or regurgitation. Moreover, the patient had no symptoms of GERD at that time and remained medication-free.

Bottom Line: Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited.This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food.The role of performing a fundoplication in these patients remains to be elucidated.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA.

ABSTRACT
Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited. This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food. The following case describes achalasia in a patient 5 years following a laparoscopic Roux-en-Y gastric bypass (RYGB). The patient underwent a laparoscopic Heller myotomy without a fundoplication. Although achalasia seems to be a rare occurrence in obese patients, this is the third case documented in a patient who previously had an RYGB. The role of performing a fundoplication in these patients remains to be elucidated.

No MeSH data available.


Related in: MedlinePlus