A 74 year-old female was referred to surgery clinic with symptoms of worsening dysphagia over the past 2 years H/E of HTN, DM II, RA, hypothyroidism, OSA Gastric Bypass done on 2013 for morbid obesity Current BMI of 40 kg/m2 EGD showed increased contractions at distal esophagus and GE junction Manometry confirmed findings and showed increased LES pressure UGI severe delay in contrast flow Non Propulsive contractions of the esophagus.
We proceeded with Robotic Heller Myotomy
Postoperatively, the patient was discharged on POD #2 tolerating liquid diet. Post operative UGI showed easy flow of contrast 2 weeks postop was seen in the clinic with complete resolution of symptoms
Surgical Heller myotomy is preferred over Per Oral Endoscopic Myotomy in patients with previous gastric bypass, due to the small gastric pouch. With appropriate minimally invasive surgical skills, robotic Heller myotomy can be safely performed in those patients and affords the patients earlier recovery and shorter length of stay.