title: Laparoscopic reoperation as management of severe gastroesophageal reflux following laparoscopic Heller myotomy for achalasia: a case report.
abstract: Achalasia is a rare disorder of the esophagus. Nonsurgical management includes oral medication, pneumatic dilatation, and injections of botulinum toxin. Surgical intervention was traditionally limited to patients with residual dysphagia after nonsurgical treatment. With the popularization of minimally invasive surgery, myotomy was increasingly performed via a laparoscopic approach. The procedure was found to be safe and efficient and is now used with increasing frequency as a primary therapeutic option. We report the case of a 17-year-old patient with achalasia in whom symptoms of gastroesophageal reflux developed following laparoscopic Heller myotomy without an antireflux procedure. Five years after surgery, the patient underwent reoperation with Toupet fundoplication. Five months after surgery, we found a normal De Meester Score and no pathologic gastroesophageal reflux. The authors conclude that laparoscopic Heller myotomy is the treatment of choice for achalasia and recommend that an antireflux procedure be included routinely.
authors.affiliation: Department of Surgery, Spital Limmattal, Schlieren, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Grigelat
authors.forename: Othmar
authors.initials: O
authors.lastname: Schöb
mesh_terms: D000293:Adolescent; D004931:Esophageal Achalasia / Q000601:surgery*; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008365:Manometry; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000379:methods