title: Surgical management for achalasia after coronary artery bypass graft using the right gastroepiploic artery: a case report.
abstract: BACKGROUND
  The right gastroepiploic artery is commonly used in coronary artery bypass grafting. Appropriate strategies are required when performing upper abdominal surgeries after the right gastroepiploic artery has been used in coronary artery bypass grafting because compressing or injuring the graft may cause myocardial ischemia and fatal arrhythmias. To our knowledge, this is the first reported case of surgery for achalasia performed after coronary artery bypass grafting using the right gastroepiploic artery. We have discussed the surgical procedure and particular intraoperative considerations.
  
  
  METHODS
  A 62-year-old man who had undergone coronary artery bypass grafting using the right gastroepiploic artery presented with achalasia. Because medication and balloon dilation had been ineffective and he was having difficulty ingesting food, we performed a Heller-Dor procedure via laparotomy. The right gastroepiploic artery was not damaged during this surgery, and there were no perioperative cardiovascular complications. Adequate control of symptoms was achieved.
  
  
  CONCLUSIONS
  When performing upper abdominal surgeries after coronary artery bypass grafting with the right gastroepiploic artery, it is necessary to investigate the patient carefully preoperatively and adapt the intraoperative procedure to minimize risk of injury to the graft and consequent cardiovascular complications.
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Muranushi
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan. tatsuyamiyazaki@gunma-u.ac.jp.
authors.forename: Tatsuya
authors.identifier: http://orcid.org/0000-0002-3258-1167
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Kuriyama
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kumakura
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Honjyo
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Yokobori
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sakai
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sohda
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
keywords: Achalasia; Coronary artery bypass graft; Right gastroepiploic artery