Abstract
Description
We present in this video a case of laparoscopic surgical repair of an esophageal perforation during pneumatic dilation for achalasia. When diagnososed with achalasia and offered adequate treatment, the patient chose pneumatic dilation. We followed the protocol used in the European trial but, after the second dilation with a 3.5 cm balloon, a perforation of the esophageal wall occurred. Gastrografin swallow and a CT confirmed the perforation. For the worsening conditions of the patient, we preferred the surgical treatment, as opposed to the conservative one. At laparoscopy, the lesion was well visible on the left lateral wall of the esophagus, 2 cm above the cardia. The mucosa was sutured with interrupted stitches, and the muscular layer reconstructed with continuous suture. A Heller myotomy was then performed on the anterior esophageal wall, and a Dor fundoplication completed the operation. The patient was discharged in 7th POD and at a 1-year follow-up she is free of dysphagia. The laparoscopic surgical repair of esophageal perforation during pneumatic dilation is feasible: proper treatment of the basic disease with myotomy is necessary, however, to achieve good final results.
Disclosure
All authors have declared no conflicts of interest.
A propensity-matched comparison of cost and outcomes after esophageal stent placement or primary surgical repair for iatrogenic esophageal perforation
