Achalasia developing years after surgery for reflux disease: Case reports,laparoscopic treatment, and review of achalasia syndromes following antireflux surgery

Two case reports demonstrate the paradoxical occurrence of achalasia many y ears after the successful surgical treatment of gastroesophageal reflux dis ease (GERD). These patients had remedial surgery laparoscopically. The thre e types of achalasia syndromes that can follow antireflux surgery are discu ssed. In type 1, primary achalasia is misdiagnosed as GERD and inappropriat e antireflux surgery causes worsening dysphagia immediately after surgery w ithout any symptom-free internal. In type 2, secondary iatrogenic achalasia is seen early after antireflux surgery and is characterized by the presenc e of stenosis and scar formation at the site of the fundic wrap. Although t he motility studies resemble achalasia, the repair needs only to be taken d own and refashioned when there is no response to balloon dilatation. In typ e 3, illustrated by the case reports, primary achalasia follows antireflux surgery after a significant symptom-free internal. There is complete absenc e of any stenosis or fibrosis of the esophagus and periesophageal tissues a t remedial surgery Moreover, surgical treatment of this condition needs to include esophageal myotomy.