Jara Hernandez Gutierrez* and Aurelio F Aranzana Gómez

General Surgery, Complejo Hospitalario Universitario de Toledo, Spain

*Corresponding Author:Jara Hernandez Gutierrez, General Surgery, Complejo Hospitalario Universitario de Toledo, Spain.

Received: November 09, 2021; Published: December 30, 2021

Abstract

Achalasia is a relatively rare disease included within the group of motor disorders of the esophagus, characterized by impaired lower esophageal sphincter relaxations and the absence of esophageal peristalsis. Laparoscopic Heller myotomy has become the procedure of choice for treating primary achalasia, due to the fact that the procedure is the one that has shown the best results in terms of morbidity, mortality and recurrences. We present a 60-year-old woman diagnosed with Achalasia. We describe the procedure and show figures of the surgery. The patient underwent an extended Heller's extramucosal myotomy with intraoperative esophageal perforation at the esophagogastric junction, associating Dor type anterior antireflux technique, the surgical procedure was completed laparoscopically. There was no postoperative morbidity or mortality. At 8 months follow-up the patient was asymptomatic and with correct radiological control. The Minimally Invasive Surgery is the treatment of choice for Achalasia, it consists of an extended Heller myotomy associated with an antireflux technique. Intraoperative perforation of the esophageal mucosa always makes the procedure more difficult, and it is necessary to insist on completing the myotomy to avoid recurrence of the disease.

Keywords: Achalasia; Lower Esophageal Sphincter; Extended Heller's Extramucosal Myotomy; Esophageal Perforation; Minimally Invasive Surgery; Laparoscopic Surgery;

References

1. Vazquez de Echarri J. “Tratamiento laparoscopico de la achalasia”. Guía Clínica de cirugía Endoscópica. AEC. Capitulo 22.
2. Mora F. “Trastornos Motores del musculo liso”. Guía Clínica de cirugía Esofagogástrica. AEC. Capitulo 10.
3. Spechler SJ. “American gastroenterological association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus”. Gastroenterology 117 (1990): 229.
4. Vaezi MF., et al. “ACG clinical guideline: diagnosis and management of achalasia”. American Journal of Gastroenterology 108 (2013): 1238.
5. Sadowski DC., et al. “Achalasia: incidence, prevalence and survival. A population-based study”. Neurogastroenterology Motil 22 (2010): e256.
6. Boeckxstaens GE., et al. “Achalasia”. Lancet 383 (2014): 83.
7. Lynch KL., et al. “Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature”. American Journal of Gastroenterology 107 (2012): 1817.
8. Swanstrom LL., et al. “Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure”. Annals of Surgery 256 (2012): 659-667.
9. “Guidelines for the Surgical Treatment of Esophageal Achalasia”. Society of American Gastrointestinal and Endoscopic Surgeons.
10. Spechler S J. “Achalasia: Pathogenesis, clinical manifestations, and diagnosis”. Uptodate.
11. Spechler S J. “Overview of the treatment of achalasia”. Uptodate.
12. Oelschlager B K. “Surgical myotomy for achalasia”. Uptodate.

Citation

Citation: Jara Hernandez Gutierrez and Aurelio F Aranzana Gómez. “Minimally Invasive Surgery for Achalasia: Laparoscopic Heller Myotomy with Accidental Esophageal Perforation". Acta Scientific Gastrointestinal Disorders 5.1 (2022): 57-66.

Copyright

Copyright: © 2022 Jara Hernandez Gutierrez and Aurelio F Aranzana Gómez. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.