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Robotic Myotomy and Partial Fundoplication for Achalasia
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Extreme achalasia presenting as anorexia nervosa
1Division of Surgery, Stepping Hill Hospital, Poplar Gove, Hazel Grove, Stockport SK2 7JE, UK.
Case Reports in Surgery
|October 24, 2012
Summary
For patients with severe achalasia and extreme weight loss, a staged approach involving laparoscopic feeding jejunostomy for nutritional support before laparoscopic Heller myotomy offers a safe and effective treatment strategy.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Achalasia, if diagnosed late, can lead to cachexia, increasing surgical risks.
- Cachectic patients undergoing surgery for achalasia face hazardous complications and prolonged recovery.
Purpose of the Study:
- To present a stepwise laparoscopic surgical approach for managing achalasia in extremely cachectic patients.
- To evaluate the safety and efficacy of a staged intervention involving nutritional rehabilitation prior to definitive surgery.
Main Methods:
- A patient with severe achalasia and a low BMI (<17) underwent laparoscopic feeding jejunostomy (LFJ) for home enteral nutrition (HEN).
- Following nutritional restoration and normalization of BMI, the patient proceeded to laparoscopic Heller myotomy (LHM).
Main Results:
- The patient demonstrated a good recovery after the staged surgical intervention.
- The stepwise approach, including LFJ for nutritional support, facilitated safe definitive surgery.
Conclusions:
- Extreme weight loss is common in advanced achalasia.
- Home enteral nutrition via a laparoscopically placed jejunostomy enables weight gain, making definitive surgery safer in cachectic patients.
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