Laparoscopic esophago-gastrostomy in the management of achalasia cardia - A case report.

INTRODUCTION: Achalasia is a rare primary motor disorder of the esophagus presenting with a classical triad of symptoms comprising dysphagia, regurgitation and weight loss. It is diagnosed from esophagogram which needs medical and surgical intervention.

PRESENTATION OF CASE: A 63-year-old woman with dysphagia was admitted to our hospital. Endoscopy revealed a dilated distal and middle oesophagus with constriction of GE junction. Barium swallow revealed narrowing of GE junction and gross dilatation of oesophagus, thus diagnosed Stage III achalasia. It was treated with a laparoscopic oesophagogastrostomy using five-port technique. The gastrohepatic omentum was opened. Followed by division of the gastrophrenic attachments over the anterior aspect of the left crus. Then anterior wall of stomach was incised using a cautery. Endostapler was introduced through the gastrostomy, one blade introduced at the fundus and other at the lower end of esophagus, all confirmed endoscopically. Anterior surface of lower end of esophagus was approximated with fundus of stomach by endostapler creating new Gastroesophageal junction. Port site closure was done using PDS. There were no postoperative complications. Follow-up after 32 months did not reveal any structural changes in upper GI endoscopy and the patient, on PPIs and prokinetic drugs has been free from symptoms upto date.

DISCUSSION: The surgical treatment for stage III achalasia is a matter of controversy. Here a patient with stage III achalasia in whom laparoscopic esophago-gastrostomy was successfully performed.

CONCLUSION: The primary treatment for stage III achalasia is esophagectomy. Laparoscopic esophagogastrostomy which is less invasive approach represents an alternative to esophagectomy and laparoscopic Heller Myotomy.