Endoscopic management of esophageal leak post-heller myotomy for achalasia cardia in children

Abstract This patient underwent Laparoscopic heller's cardiomyotomy and Nissen fundoplication for Achalasia cardia at another institute. Following surgery his dysphagia worsened. Dysphagia persisted despite balloon dilatation. Patient was evaluated at our institute with Barium swallow and CECT thorax which showed dilated oesophagus with tight wrap. Patient was planned for laparoscopic re exploration. At surgery he had a Nissen wrap and inadequate extension of myotomy across the GE junction. Methods The video describes the procedure of laparoscopic dismantling of the wrap with extension of Heller myotomy and a Toupet Fundoplication. Results Patient had an uneventful recovery and had significant improvement in dysphagia at a follow up of 7 months. Conclusion Nissen Fundoplication is not a good choice of antireflux procedure in achalasia cardia patients following Heller Myotomy and can contribute to dysphagia in the post operative period. Extension of myotomy across the GE junction is critical to the success of Heller myotomy. Re-do surgery is difficult but can be be accomplished through approach in experienced hands. Video https://drive.google.com/file/d/1dhs-PlUm-ahDGF63VxxM0htB0dRiAGYJ/view?usp=sharing

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Intermittent neck swelling: an unusual presentation of achalasia cardia

BMJ Case Reports ◽

10.1136/bcr-2021-243229 ◽

2021 ◽

Vol 14 (9) ◽

pp. e243229

Author(s):

Piriyanga Kesavan ◽

Shivani Joshi ◽

Yüksel Gercek

Keyword(s):

Weight Loss ◽

Heller Myotomy ◽

Delayed Diagnosis ◽

Barium Swallow ◽

Airway Compromise ◽

Neck Swelling ◽

Achalasia Cardia ◽

Food Residue ◽

Oesophageal Myotomy ◽

Botulinum Toxin Injections

Achalasia is a rare cause of neck swelling. We report the case of a 75-year-old woman, who presented with an intermittent, unilateral neck swelling, associated with dysphagia, weight loss and regurgitation. The patient underwent a gastroscopy and barium swallow. This confirmed a dilated oesophagus with poor motility and hold up of liquid and food residue above the gastro-oesophageal junction, thus revealing the swelling was secondary to severe achalasia. The patient was managed with botulinum toxin injections and pneumatic dilatations but the results were short lived. She is now having manometry and is being considered for a Heller myotomy or peroral oesophageal myotomy. Delayed diagnosis and treatment of achalasia can result in the development of a neck swelling, which could later cause airway compromise and subsequent mortality. Achalasia should therefore be considered in patients with an initial diagnosis of gastro-oesophageal reflux disease who do not respond to proton pump inhibitors.

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386 LAPAROSCOPIC HELLERS MYOTOMY AND ANGLE OF HIS ACCENTUATION FOR ACHALASIA CARDIA: 10 YEARS EXPERIENCE FROM A SINGLE SURGICAL CENTRE.

Diseases of the Esophagus ◽

10.1093/dote/doaa087.94 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

R Parshad ◽

V Singla ◽

S Suhani ◽

H Bhattacharjee ◽

G Makharia ◽

...

Keyword(s):

Quality Of Life ◽

Heller Myotomy ◽

Laparoscopic Heller Myotomy ◽

Antireflux Procedure ◽

Barium Swallow ◽

Symptom Duration ◽

Life Questionnaire ◽

Achalasia Cardia ◽

Dysphagia Score

Abstract Achalasia is a rare disease with Laparoscopic Hellers cardio-myotomy (LHCM) being the gold standard surgical modality. An antireflux procedure is required along with myotomy to decrease the chances of reflux postoperatively. We have performed Angle of His Accentuation (AOH) as an anti-reflux procedure in 126 patients who underwent LHCM since 2010. This study presents the symptomatic and objective outcomes of LHCM with AOH. Methods Review of prospectively collected data of patients with Achalasia cardia undergoing LHCM with AOH from 2010–2019. Subjective symptoms were scored for dysphagia, heartburn, regurgitation and quality of life using scoring systems mentioned in table 1 and Achalasia specific health related Quality of life questionnaire (ASHRQoL). Objective tests included Timed Barium swallow, Endoscopy and high-resolution manometry. Patients were evaluated in pre and postoperative period at regular intervals. Success was defined as follows: Eckardt score of ≤3, Dysphagia score of 0/1, Regurgitation and heartburn score of 0, >50% clearance on timed barium swallow, IRP <15 and absence of esophagitis. Results 126 patients were operated during the study period with no mortality or conversion. Mean age was 33.5(years), symptom duration 49.8(months), 31 had preoperative dilatation. The mean operative time was 131 (minutes). Subjective outcome was available in all patients & objective data in 66. At median follow of 31 months (IQR 15–59) outcomes significantly improved (Table 1) with 93% having dysphagia relief. 14 (11%) had new onset heartburn; 6(4.7%) needed regular proton pump inhibitors. ASHRQoL improved significantly (59.51 to 19.57). Pre&post-operative IRP, Timed Barium and endoscopy available in 66,39 and 62 patients improved significantly. 6(9.6%) patients had endoscopic evidence of esophagitis (LA-A 3, B/C 3). Conclusion Laparoscopic Heller myotomy with Angle of His accentuation is safe simple and effective procedure for Achalasia cardia. It provides significant relief of symptoms, improvement in quality of life and improvement in objective parameters. Post- operative heartburn and esophagitis is acceptable. We recommend Angle of His accentuation as an adjunct to Laparoscopic Heller myotomy.

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Achalasia Cardia – Recent Advances in Diagnosis and Endoscopic Management

Journal of Gastrointestinal & Digestive System ◽

10.4172/2161-069x.1000393 ◽

2016 ◽

Vol 06 (01) ◽

Cited By ~ 1

Author(s):

Zaheer Nabi ◽

Duvvur Nageshwar Reddy

Keyword(s):

Endoscopic Management ◽

Achalasia Cardia ◽

Recent Advances

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Retrograde gastroesophageal intussusception: an exceedingly rare complication of Heller myotomy in a patient with achalasia cardia

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2017.17057 ◽

2017 ◽

Vol 28 (4) ◽

pp. 316-318 ◽

Cited By ~ 1

Author(s):

Ishan Kumar ◽

Richa Singh Chauhan ◽

Ashish Verma

Keyword(s):

Heller Myotomy ◽

Rare Complication ◽

Achalasia Cardia

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Symptomatic and Physiological Outcomes Following Laparoscopic Heller Myotomy for Achalasia Cardia

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0000000000001034 ◽

2022 ◽

Vol Publish Ahead of Print ◽

Author(s):

Aditya Kumar ◽

Samarendra N. Tripathi ◽

Sonali Mittal ◽

Joyner Abraham ◽

Govind K. Makharia ◽

...

Keyword(s):

Heller Myotomy ◽

Laparoscopic Heller Myotomy ◽

Achalasia Cardia ◽

Physiological Outcomes

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Diagnostics and Minimally Invasive Surgery for Achalasia Cardia

Galician Medical Journal ◽

10.21802/gmj.2018.4.13 ◽

2018 ◽

Vol 25 (4) ◽

Author(s):

Vadim Ratchik ◽

Oleksandr Babii ◽

Natalia Prolom ◽

Boris Shevchenko

Keyword(s):

Heller Myotomy ◽

Disease Duration ◽

Balloon Dilation ◽

Laparoscopic Heller Myotomy ◽

Group Iv ◽

Pneumatic Dilation ◽

Achalasia Cardia ◽

Group Iii ◽

Group I ◽

Pneumatic Balloon Dilation

The objective of the research was to assess the effectiveness of balloon pneumatic dilation and laparoscopic Heller myotomy in treatment of patients with achalasia cardia. Materials and methods. Twenty-one patients with achalasia cardia were examined and treated using pneumatic balloon dilation and laparoscopic Heller myotomy in the Department of Surgery from January 2016 to April 2018. There were 8 (38.1%) men and 13 (61.9%) women at the age of 28 to 75 years (the average age was (51.47 ± 3.63) years) and disease duration of 1 month to 8 years (the average disease duration was (3.05 ± 0.49) years). Results and discussion. With the help of radiological methods of examination, all the patients were divided into 4 groups according to the esophageal diameter: Group I included 5 (23.8%) patients with the esophagus up to 4-5 cm in diameter; Group II comprised 6 (28.6%) patients with the esophagus up to 4-6 cm in diameter; Group III included 5 (23.8%) patients with the esophagus up to 6-8 cm in diameter; Group IV consisted of 5 (23.8%) patients with the esophagus of more than 8 cm in diameter and an S-shaped configuration. A significant decrease in the diameter of the esophagus according to fluoroscopy (p<0.05) alongside with a decrease in the lower esophageal sphincter pressure according to manometry are indicative in assessing the effectiveness of achalasia cardia treatment after minimally invasive surgery. There were no complications when performing pneumatic balloon dilation and laparoscopic Heller myotomy. Conclusions. In 7 (33.3%) patients, recurrences of achalasia cardia after balloon pneumatic dilation occurred within 2 - 10 months: in 4.7% of patients in Group I and 9.5% of patients in Group II, Group III, and Group IV. In recurrent achalasia cardia, repeated dilation was ineffective. There was performed laparoscopic Heller myotomy with Dor fundoplication, which was effective in 80.0% of cases.

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