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Pseudoachalasia occurring after laparoscopic Nissen fundoplication and crural mesh repair
Authors:Luigi Bonavina  Davide Bona  Greta Saino  Claudio Clemente
Institution:(1) Department of Medical and Surgical Sciences, Surgical Unit, I.R.C.C.S. Policlinico San Donato, University of Milan School of Medicine, Milan, Italy;(2) Pathology Unit, I.R.C.C.S. Policlinico San Donato, University of Milan School of Medicine, Milan, Italy;(3) U.O. Chirurgia Generale, Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
Abstract:Background Benign esophageal pseudoachalasia is a rare condition. Discussion We report the case of a 70-year-old man who complained of severe dysphagia after laparoscopic Nissen fundoplication and crural mesh repair performed for long-standing gastroesophageal reflux disease. Severe dysphagia and nocturnal aspiration developed soon after the operation. A marked dilatation of the esophageal body and a manometric pattern resembling achalasia was documented. Results Endoscopic balloon dilatation was ineffective. Five months after the initial operation, the patient underwent revisional laparoscopic surgery that consisted of Nissen’s wrap takedown, enlargement of the hiatus with partial resection of the mesh, Heller myotomy, and Dor fundoplication. After a 2-year follow-up, the patient is doing well and is free of symptoms.
Keywords:Achalasia  Pseudoachalasia  Myenteric plexus  Gastroesophageal reflux disease  Laparoscopic Nissen fundoplication  Crural mesh repair  Dysphagia
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