Laparoscopic Heller myotomy after previous Roux-en-Y gastric bypassObesity has been shown to be an independent risk factor for developing esophageal motility disorders, with a prevalence of 20% to 61% [1–4]. 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.
Laparoscopic revision of chronic marginal ulcer and bilateral truncal vagotomyIn accredited centers, bariatric surgery is performed with very low mortality, morbidity, and readmission rates [1–3]. However, a small number of bariatric patients develop postoperative complications such as marginal ulcers. Previous reports cite the incidence of marginal ulcer with significant variability, from .6% to 16% . The etiology of marginal ulcers after a laparoscopic Roux-en-Y gastric bypass is a matter of debate. Many factors are believed to contribute to the development of marginal ulcers, such as smoking, ischemia, foreign body reaction, gastrogastric fistulas, large gastric pouches, and tension at the anastomosis [5–9].