Robotic Assisted Heller's Myotomy for Type II Achalasia - A Case Report

Date

2020

Authors

Nagatomo, Kei
Mai, Steven

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Abstract

Background: Type II achalasia is a rare disorder effecting 10/100,000 individuals that can lead to dysphagic symptoms impacting overall quality of life. Traditionally preferred treatment options include pneumatic dilation, laparoscopic operation, and peroral endoscopic myotomy. Robotic-assisted surgeries have demonstrated technical advantages over laparoscopic approaches, including improved precision, decreased blood loss and hospital stay, and ultimately, improved patient outcomes. Here we report a favorable robotic approach to the Heller's myotomy. Case Presentation: A 54-year-old Caucasian female presents with a complaint of worsening dysphagia for the past 6 months. The patent had thorough workup including an upper gastrointestinal barium swallow study and manometry study. These respective studies showed a classic "bird beak" appearance and elevated panesophagus pressure, which are suggestive of type II achalasia. The patient underwent esophageal gastroduodenoscopy to rule out a malignant cause. She previously underwent esophageal dilation which provided mild symptom relief but ultimately left dissatisfied and required surgical management. Following her robotic surgery, the patient returned to the medicine floor where she received a post-operative UGI study showing tortuous esophagus without constriction. She was discharged on day two without complication. Two weeks later, she returned to the clinic and she endorsed improvement without complication, and was encouraged to advance her diet slowly. Conclusion: This case demonstrates the robotic-assisted approach to the Heller's myotomy to be a favorable alternative management of patients suffering from Type II achalasia.

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