The surgical management of achalasia in the morbid obese patient

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
P Marco FisichellaMarco G Patti

Abstract

Morbid obesity and achalasia may coexist in the same patient. The surgical management of the morbidly obese patient with achalasia is complex, and the most effective treatment still remains controversial. The goal of our report is to provide our evidence-based approach for the surgical management of the patient with achalasia and morbid obesity. Three main surgical approaches have been used for the concomitant treatment of morbid obesity and achalasia: 1) a laparoscopic Heller myotomy and a laparoscopic Roux-en-Y gastric bypass (LRYGB); 2) a laparoscopic Heller myotomy with bilio-pancreatic diversion; and 3) a laparoscopic Heller myotomy with a sleeve gastrectomy. Our approach of choice is the first one discussed, that is the laparoscopic Heller myotomy with a LRYGB, as this approach can provide excellent relief of symptoms and control of reflux while at the same time treating obesity and its comorbidities. Achalasia and obesity can coexist, albeit infrequently. A laparoscopic Heller myotomy with a LRYGB allows the simultaneous treatment of both diseases. When a morbidly obese patient with achalasia chooses to have a myotomy alone and not a LRYGB, a thorough discussion of the risks and benefits should occur and the autonomy of ...Continue Reading

References

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Oct 25, 2007·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Marco G Patti, Piero M Fisichella
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Jul 8, 2014·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Han Boon OhAsim Shabbir

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Citations

Jan 10, 2018·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·T H TaftJ E Pandolfino
Oct 18, 2019·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Igor WildermanLukasz Zolnierczyk
Jul 16, 2019·Journal of Clinical Gastroenterology·Madhusudhan R SanakaSiva Raja
Jun 17, 2020·European Journal of Gastroenterology & Hepatology·Pamela MilitoLuigi Bonavina
Jun 20, 2020·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Javier Ithurralde-ArgerichFederico Cuenca-Abente
Jun 26, 2020·Langenbeck's Archives of Surgery·Jon M HarrisonKaren A Chojnacki
Nov 7, 2019·Updates in Surgery·María A CasasMarco G Patti
Jul 1, 2021·Arquivos De Gastroenterologia·Eponina Maria de Oliveira LemmeGuilherme Lemos Cotta Pereira
Nov 30, 2020·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Ana LaranjoGuilherme Macedo

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