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Laparoscopic Heller myotomy after previous Roux-en-Y gastric bypass

Published:August 25, 2017DOI:https://doi.org/10.1016/j.soard.2017.08.013
      Obesity has been shown to be an independent risk factor for developing esophageal motility disorders, with a prevalence of 20% to 61% [
      • Jaffin B.W.
      • Knoepflmacher P.
      • Greenstein R.
      High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients.
      ,
      • Ramos A.C.
      • Murakami A.
      • Lanzarini E.G.
      • Neto M.G.
      • Galvão M.
      Achalasia and laparoscopic gastric bypass.
      ,
      • Almogy G.
      • Anthone G.J.
      • Crookes P.F.
      Achalasia in the context of morbid obesity: a rare but important association.
      ,
      • Boules M.
      • Corcelles R.
      • Zelisko A.
      • et al.
      Achalasia after bariatric surgery.
      ]. Achalasia is a rare primary esophageal motility disorder that is even more rare among the obese population. It is characterized by aperistalsis of the esophagus and lack of relaxation of the lower esophageal sphincter. Associated symptoms in the nonobese patient include dysphagia, regurgitation, reflux, and weight loss. On the contrary, among the obese population regurgitation, cough and aspiration are the presenting symptoms. Atypical symptoms in the obese can create a challenge in diagnosis and management. Achalasia after bariatric surgery has limited data [
      • Ramos A.C.
      • Murakami A.
      • Lanzarini E.G.
      • Neto M.G.
      • Galvão M.
      Achalasia and laparoscopic gastric bypass.
      ,
      • Boules M.
      • Corcelles R.
      • Zelisko A.
      • et al.
      Achalasia after bariatric surgery.
      ,
      • Chapman R.
      • Rotundo A.
      • Carter N.
      • George J.
      • Jenkinson A.
      • Adamo M.
      Laparoscopic Heller's myotomy for achalasia after gastric bypass: a case report.
      ,
      • Oh H.B.
      • Tang S.-W.
      • Shabbir A.
      Laparoscopic Heller's cardiomyotomy and Roux-En-Y gastric bypass for missed achalasia diagnosed after laparoscopic sleeve gastrectomy.
      ,
      • Johnson W.D.
      • Marshall M.B.
      Surgical management of achalasia in a patient with previous gastric bypass.
      ] but will likely become more apparent with increasing case volumes in the foreseeable future.

      Keywords

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