Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2019; 11(2): 112-116
Published online Feb 27, 2019. doi: 10.4240/wjgs.v11.i2.112
Esophagogastric junction outflow obstruction successfully treated with laparoscopic Heller myotomy and Dor fundoplication: First case report in the literature
Pedro F Pereira, Andre RP Rosa, Leonardo A Mesquita, Marcelle J Anzolch, Rafael N Branchi, Augusto L Giongo, Francisco C Paixão, Marcio F Chedid, Cleber DP Kruel
Pedro F Pereira, Andre RP Rosa, Leonardo A Mesquita, Marcelle J Anzolch, Rafael N Branchi, Augusto L Giongo, Francisco C Paixão, Marcio F Chedid, Cleber DP Kruel, Division of Gastrointestinal Surgery and Liver Transplantation, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre 90035-903, Brazil
Author contributions: Pereira PF, Rosa AR, Mesquita LA, Anzolch MJ, Branchi RN, Giongo AL, Paixão FC, Chedid MF, Kruel CD, contributed with methodology, data acquisition, data presentation and writing of an original draft of the manuscript; Kruel C, Rosa AR and Chedid MF contributed with methodology; conceptualization, and supervision; all authors conducted critical revisions and approved the final version of the manuscript.
Supported by Research and Events Support Fund at Hospital de Clí nicas de Porto Alegre.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marcio F Chedid, MD, PhD, Professor, Surgeon, Division of Gastrointestinal Surgery and Liver Transplantation, Hospital de Clinicas de Porto Alegre, Medical School of Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, 6th Floor, Room 600, Porto Alegre 90035-903, Brazil. marciochedid@hotmail.com
Telephone: +55-51-997721980
Received: January 26, 2019
Peer-review started: January 27, 2019
First decision: February 19, 2019
Revised: February 21, 2019
Accepted: February 21, 2019
Article in press: February 22, 2019
Published online: February 27, 2019
Abstract
BACKGROUND

Esophagogastric junction outflow obstruction (EGJOO) is a rare syndrome, characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. We were unable to find any prior report of the combination of Heller myotomy with anterior partial fundoplication (Dor) as the treatment for EGJOO. We herein report a case of EGJOO treated with laparoscopic Heller myotomy combined with Dor fundoplication.

CASE SUMMARY

A 26-year-old man presented with a 3-year history of solid dysphagia and a 30-kg weight loss. He was treated with oral nifedipine, isosorbide, and omeprazole, without resolution of symptoms. An upper gastrointestinal series (barium swallow) revealed a “bird’s beak” sign. Esophagogastroduodenoscopy was positive for Los Angeles grade A peptic esophagitis. High-resolution esophageal manometry was compatible with EGJOO. Esophageal pH monitoring showed pathological acid reflux both in orthostatic and decubitus position. An 8-cm laparoscopic Heller myotomy combined with an anterior 220° Dor fundoplication was performed. Solid diet was introduced on postoperative day 2, and the patient was discharged home the same day. At 17-mo follow-up, he reported no symptoms. Barium swallow was compatible with complete radiologic resolution. Both esophageal manometry and upper endoscopy showed normal findings 9 mo after the operation.

CONCLUSION

Surgical treatment with Heller myotomy and Dor fundoplication is a potential treatment option for EGJOO refractory to medical treatment.

Keywords: Esophagogastric junction outflow obstruction, Heller myotomy, Partial fundoplication, Dor fundoplication, Case report

Core tip: Esophagogastric junction outflow obstruction (EGJOO) is a rare syndrome, characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. Surgical treatment of EGJOO is very rarely considered and very few cases have been reported in the medical literature. We herein report the first case of EGJOO successfully treated with laparoscopic Heller myotomy combined with Dor fundoplication.