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 Heller myotomy and gastric bypass for achalasia after vertical banded gastroplastyThe incidence of esophageal motility disorders in morbidly obese patients has not been well established. Some studies have suggested that although the prevalence of these disorders might be greater than in the normal population, obese patients might not necessarily develop symptoms . Therefore, esophageal motility disorders can be overlooked during preoperative testing and the evaluation for bariatric surgery and only become apparent after surgery. In other patients, esophageal motility disorders might arise de novo after the procedure or arise as a complication of the procedure.