Laparoscopic Heller′s cardiomyotomy in cirrhosis with oesophageal varices

Abstract

Surgical intervention in cirrhosis of liver with portal hypertension is associated with increased morbidity and mortality. This is attributed to liver decompensation, intra-operative bleeding, prolonged operative time, wound related and anaesthesia complications. Laparoscopic surgery in cirrhosis is advantageous but is associated with technical challenges. We report one such case of hepatitis C cirrhosis with oesophageal varices and symptomatic achalasia cardia, who was successfully treated by laparoscopic cardiomyotomy after thorough preoperative workup and planning. In the review of literature on pubmed, no such case is reported.

The treatment of achalasia patients with esophageal varices: an international study

“…Although recognized as one of the most common major esophageal motor disorders, achalasia represents a rare condition with an estimated prevalence of 10 in 10,000 and an incidence rate ranging from 1.07 to up to 2.8 new cases per year per 100,000 population 22 , 23 . The coexistence of esophageal varices with achalasia is therefore infinitely rare, and to the best of our knowledge, is described in literature in only a small number of isolated case reports 3–13 . A common presenting symptom of achalasia is restricted caloric intake and subsequent weight loss.…”

“…The presence of portal hypertension with varices is infinitely rarely reported to occur in conjunction with achalasia and the choice of treatment in this context represents a challenging therapeutic dilemma, even in specialized centers. To the best of our knowledge, 12 cases reports have been described in the literature with only eight patients having received treatment 3–13 . The limitation of oral food intake and subsequent weight loss observed in achalasia will inevitably have detrimental consequences in cirrhotic patients; significant weight loss and malnutrition could aggravate pre‐existing hypoalbuminemia, precipitating cirrhosis complications (i.e.…”

“…To the best of our knowledge, 12 cases reports have been described in the literature with only eight patients having received treatment. 3–13 The limitation of oral food intake and subsequent weight loss observed in achalasia will inevitably have detrimental consequences in cirrhotic patients; significant weight loss and malnutrition could aggravate pre-existing hypoalbuminemia, precipitating cirrhosis complications (i.e. ascites and spontaneous bacterial peritonitis) and expose patients to cachexia and/or vitamin deficiency and its sequelae.…”

Peroral Endoscopic Myotomy for the Treatment of Achalasia in a Patient with Esophageal Varices. A Case Report

“…Three patients were treated with EUS-guided BTI [2,3,5]. The last patient received a laparoscopic Heller myotomy (LHM) [4]. The combination of achalasia with esophageal varices from cirrhosis with portal hypertension prompted us to consider the treatment effects and the risk of hemorrhage from a combination of varices, thrombocytopenia, and coagulation abnormalities.…”

“…Ten cases have been reported in the English medical literature, seven of which received treatment [2][3][4][5]. However, these treatments often involved various risks and complications, such as risk of hemorrhage after thoracotomy, dysphagia recurrence requiring subsequent myotomy after botulinum toxin injections (BTI), and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS).…”