Mechanical and neurogenic factors in postvagotomoy dysphagia

Postvagotomy dysphagia (PVD) has been attributed to either periesophageal obstruction or failure of the lower esophageal sphincter (LES) to relax, presumably from interruption of preganglionic, contraction-inhibiting vagal fibers--a postvagotomy achalasia (PVA). This report describes a patient with periesophageal fibrosis which was successfully treated with dilation, and a second patient with an achalasia-like pattern on esophageal manometry after unilateral high, transthoracic vagotomy. The second patient is the first manometrically documented example of achalasia in a human subject related to proximal vagotomy. Most, if not all, PVD is due to esophageal obstruction and PVA is rare.