Roux-en-Y Gastric Bypass and Heller Myotomy: One-Step Surgical Treatment of Symptomatic Achalasia in a Morbid Obese Patient

Excerpt

Achalasia is a rare disorder of esophageal motility characterized by the absence of peristalsis and incomplete lower esophageal sphincter (LES) relaxation during swallowing. It usually presents with progressive severe dysphagia and its most effective treatment is surgical disruption of the LES with a Heller myotomy (HM) [1]. Obesity is an independent risk factor for esophageal motility disorders, which may exist in >50% of morbidly obese patients [2]. However, obesity is not generally associated with achalasia and the prevalence of this disease in obese patient population varies from 0.5 to 1% [3]. Bariatric surgery currently represents the best treatment option for morbid obesity and its related diseases and laparoscopic Roux-en-Y gastric bypass (LRYGB) is the second most commonly performed procedure in the world [4]. At same time, HM has demonstrated its superiority over other treatments for achalasia [5]. However, resolution of achalasia symptoms with only laparoscopic HM, expose an obese patient to the risk for further weight gain. Even though the separated management of the two pathologies is well described, current literature lack of consistency about a simultaneous treatment [6, 7]. …