Heller oesophagomyotomy as treatment for achalasia after gastric bypass for morbid obesity

Nguyen, David; Dip, Fernando; Menzo, Emanuele Lo; Szomstein, Samuel; Rosenthal, Raúl J.

doi:10.1308/rcsann.2016.0006

Cited by 7 publications

(2 citation statements)

References 5 publications

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“…We performed a literature search using MEDLINE (2005-2023) with search terms including "achalasia," "distal gastrectomy," and "laparoscopic Heller myotomy," but we identified no reports similar to our case, although some reports after bariatric surgery were identified. 4,5,9,10 However, we are aware that similar cases must exist, and we therefore believe it is important to share the findings. Overall, we suggest that laparoscopic Heller myotomy with Dor fundoplication is an effective treatment option for esophageal achalasia after gastric surgery.…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic Heller myotomy with Dor fundoplication for esophageal achalasia treatment after distal gastrectomy and Billroth‐II reconstruction

Nakajima

Masuda

Takahiro

et al. 2023

Asian J Endoscop Surgery

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Laparoscopic Heller myotomy with Dor fundoplication is the standard surgical treatment for esophageal achalasia. However, there are few reports on the use of this method after gastric surgery. We report a case of a 78-year-old man who underwent laparoscopic Heller myotomy with Dor fundoplication for achalasia after distal gastrectomy and Billroth-II reconstruction. After the intraabdominal adhesion was sharply dissected using an ultrasonic coagulation incision device (UCID), Heller myotomy was performed 5 cm above and 2 cm below the esophagogastric junction using the UCID. To prevent postoperative gastroesophageal reflux (GER), Dor fundoplication was performed without cutting the short gastric artery and vein. The postoperative course was uneventful, and the patient is in good health without symptoms of dysphagia or GER. Although per-oral endoscopic myotomy is becoming the mainstay of treatment for achalasia after gastric surgery, laparoscopic Heller myotomy with Dor fundoplication is also an effective strategy.

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Section: Discussionmentioning

confidence: 97%

Laparoscopic Heller myotomy with Dor fundoplication for esophageal achalasia treatment after distal gastrectomy and Billroth‐II reconstruction

Nakajima

Masuda

Takahiro

et al. 2023

Asian J Endoscop Surgery

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“…In obese patients, LHM is associated with suboptimal clinical outcomes or high rate of postoperative GERD. 50 A growing body of research has proposed POEM as an exciting option for management of achalasia before or after a Roux-en-Y gastric bypass (RYGB). A recent review by Aiolfi et al 51 including 12 studies with 28 patients summarized the current treatments for achalasia after RYGB.…”

Section: Special Situations Obese Patientsmentioning

confidence: 99%

<p>Peroral Endoscopic Myotomy as a Novel Treatment for Achalasia: Patient Selection and Perspectives</p>

Chadalavada¹,

Thota²,

Raja³

et al. 2020

CEG

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Achalasia is a rare esophageal motility disorder characterized by esophageal aperistalsis and impaired relaxation of lower esophageal sphincter. There is no cure for achalasia and all the current treatments are aimed at palliation of symptoms by reducing the lower esophageal sphincter pressure. Currently, laparoscopic Heller myotomy (LHM) with partial fundoplication is considered the most effective and durable treatment option owing to its superiority over other treatments such as pneumatic dilation. Advancements in interventional endoscopy led to a novel minimally invasive endoscopic alternative to LHM, namely peroral endoscopic myotomy (POEM). In the last decade since its inception, POEM expanded rapidly throughout the world due to excellent safety profile and its efficacy comparable to LHM. The main drawback of POEM is gastroesophageal reflux disease since it is not combined with an anti-reflux procedure. The current review focuses on the indications, contraindications, technique, outcomes of POEM in various patient populations, and complications along with its effectiveness in comparison to LHM and pneumatic dilation.

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Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis

Kunz,

Ashraf,

Klonis

et al. 2023

Langenbecks Arch Surg

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Purpose Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. Methods A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. Results Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller’s myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. Conclusion In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success.

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Heller oesophagomyotomy as treatment for achalasia after gastric bypass for morbid obesity

Cited by 7 publications

References 5 publications

Laparoscopic Heller myotomy with Dor fundoplication for esophageal achalasia treatment after distal gastrectomy and Billroth‐II reconstruction

Laparoscopic Heller myotomy with Dor fundoplication for esophageal achalasia treatment after distal gastrectomy and Billroth‐II reconstruction

<p>Peroral Endoscopic Myotomy as a Novel Treatment for Achalasia: Patient Selection and Perspectives</p>

Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis

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