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Laparoscopic assisted transhiatal esophagectomy for a case of end-stage achalasia cardia post Heller's myotomy and fundoplication along with severe dysplasia of esophagus



Achalasia is an idiopathic disorder of esophagus involving lower esophageal sphincter (LES), characterized by insufficient relaxation of LES and absence of esophageal peristalsis. We present a case report of a 44 year old female presenting with complaints of difficulty in swallowing for ten years. She underwent laparoscopic Hellers myotomy and anterior fundoplication for the disease but continued to have symptoms of dysphagia. On evaluation upper GI endoscopy showed features of dilated esophagus suggestive of achalasia. Esophageal manometry, barium esophagogram and CT chest with abdomen revealed dilated esophagus suggestive of achalasia. Endoscopy showed end stage achalasia and biopsy revealed severe dysplasia.                    Laparoscopic assisted transhiatal esophagectomy was done for the patient. Histopathology report showed features of  dysplasia and carcinoma in situ. Definitive treatment was done for this unique condition of end stage achalasia after failed myotomy and histological features of severe dysplasia in the esophagus.


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Katz PO, Gerson LB, Vela MF, Guidelines for the diagnosis and management of gastroesphageal reflux disease. Am J Gastroenterol 2013;108:308-28;quiz 29.

Charles JYeo MD Shackelford’s surgery of the alimentary tract 7th Edition volume I Chapters 9 & 20.

Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992;103:

Bonatti H, Hinder RA, Klocker J et al. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg 2005;190:874-8.

Costantini M, Zaninotto G, Guirroli E al. The laproscopic Heller-Dor operations remains an effective treatment for esophageal achalasia ar a minimum 6-year follow-up. Surg Endosc 2005;19:345-51.

Petres JH, Kauer WK, Crookers PF et al. Esophageal resection with colon interposition for endstage achalasia. Arch surg 1995;130:632-636.

Orringer MB, Stirling MC. Esophageal resection for achalasia: indicatons and results. Ann Thorac Surg 1989;47:340-5.


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