Laparoscopic assisted transhiatal esophagectomy for a case of end-stage achalasia cardia post Heller's myotomy and fundoplication along with severe dysplasia of esophagus

Achalasia is an idiopathic disorder of esophagus involving lower esophageal sphincter (LES), characterized by insufficient relaxation of LES and absence of esophageal peristalsis. We present a case report of a 44 year old female presenting with complaints of difficulty in swallowing for ten years. She underwent laparoscopic Hellers myotomy and anterior fundoplication for the disease but continued to have symptoms of dysphagia. On evaluation upper GI endoscopy showed features of dilated esophagus suggestive of achalasia. Esophageal manometry, barium esophagogram and CT chest with abdomen revealed dilated esophagus suggestive of achalasia. Endoscopy showed end stage achalasia and biopsy revealed severe dysplasia. Laparoscopic assisted transhiatal esophagectomy was done for the patient. Histopathology report showed features of dysplasia and carcinoma in situ. Definitive treatment was done for this unique condition of end stage achalasia after failed myotomy and histological features of severe dysplasia in the esophagus.