Management of esophageal perforation after pneumatic dilation for achalasia

Current management of esophageal perforation after pneumatic dilation for a chalasia is thoracotomy and repair with myotomy. This study aims to assess the outcome of patients managed by laparotomy, and the role of laparoscopic repair. The study was carried out by means of retrospective case review an d prospective follow-up with a symptom questionnaire. Results were compared with results in patients undergoing elective Heller myotomy Over a 20-year period, 445 dilations for achalasia were performed in 371 patients. There were 10 esophageal perforations, Nine patients were referred for surgery an d were successfully managed with a transabdominal repair. Laparoscopic repa ir was attempted in four patients but was successful in only one because of the perforation site. After a mean follow-up of 5.4 years, grade 1 or 2 Vi sick scores were recorded in all patients. Residual symptoms of dysphagia o ccurred in 67% in the emergency group and 88% in the elective group. There was an increased incidence of heartburn compared to elective myotomy. Early operation after perforation provides good results for treatment of achalas ia. Mild dysphagia persists and there is an increasing sensation of heartbu rn. The site of perforation is typically posterolateral, which makes laparo scopic repair difficult.