Laparoscopic Heller Myotomy and Hiatal Hernia Repair After Failed Peroral Endoscopic Myotomy

Excerpt

A 45-year-old female who underwent peroral endoscopic myotomy (POEM) presented to the general surgery clinic with recurrent regurgitation and reflux. She underwent POEM 2 years prior and had symptomatic relief for 8 months. Over the past 6 months, she had frequent respiratory infections suspected to be from aspiration. Upper GI study (Fig. 1b) demonstrates esophageal dilatation, disordered contractions, significant spontaneous gastroesophageal reflux into the upper esophagus both consistent with recurrent achalasia. High-resolution manometry demonstrated normal lower esophageal sphincter pressures but absent peristalsis. Esophageal pH testing was normal. An upper endoscopy demonstrated a dilated and mildly tortuous esophagus, but no hiatal hernia was identified. The patient was taken to the operating room for a laparoscopic Heller myotomy.

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