Abstract
Background
GERD and Achalasia are two known complications after sleeve gastrectomy. Treatment towards each of these complications varies and requires a tailored approach.
Methods
We present a 55-year-old female with class II obesity and a previous history of sleeve gastrectomy who developed significant gastroesophageal reflux disease refractory to medical management. After a covid infection in fall of 2020, she began to report new symptoms of dysphagia that progressed from solids to liquids. She underwent extensive workup including upper endoscopy, upper GI barium swallow, manometry, pH impedence, and EndoFlip leading to a diagnosis of Achalasia type II as well as a paraesophageal hernia.
Results
Given these findings, she underwent a combined paraesophageal hernia repair with conversion of sleeve gastrectomy to Roux-en-Y gastric diversion and an intra-operative peroral endoscopic myotomy. Intraoperatively, she was noted to have significant lower abdominal adhesions leading to performing the Roux-en-Y reconstruction through a supramesocolic defect in a retrocolic fashion.
Conclusions
While the development of heartburn and achalasia after sleeve gastrectomy is rare, it requires interventions dedicated towards each etiology. This case demonstrates treatment of both these symptoms is feasible in a single operation.
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Key points
• Gastroesophageal reflux disease (GERD) and achalasia are known complications after sleeve gastrectomy (SG) and require different therapeutic interventions
• Myotomy for achalasia cannot be followed by fundoplication in the post-SG patient, and alternative interventions to reduce risk of GERD are needed
• Conversion to Roux-en-Y Gastric bypass (RYGB) is an accepted operative choice for patients with GERD and history of SG
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Slack, D., Colavita, P. & Nimeri, A. Laparoscopic Paraesophageal Hernia (PEH) Repair, Roux-en-Y Gastric Bypass, and Per Oral Endoscopic Myotomy (POEM) in a Patient with Achalasia After Sleeve Gastrectomy. OBES SURG 33, 1955–1956 (2023). https://doi.org/10.1007/s11695-023-06623-1
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DOI: https://doi.org/10.1007/s11695-023-06623-1