Laparoscopic Heller Myotomy EGJ Perforation Treated by Belsey Fat Pad Suturing

Laparoscopic Heller myotomy is the mainstay surgical treatment of oesophageal achalasia and has proven to be safe and effective over the course of time. Oesophageal perforation after myotomy can be a serious complication with devastating outcomes. Most commonly, mucosal perforation are detected intraoperatively or early postoperatively. Perforations discovered intra-operatively are usually treated with laparoscopic suturing. Perforations not identified at the time of operation generally present with sepsis and a leak. Accidental perforation during LHD is impossible to predict on the grounds of preoperative therapy or the surgeon's personal experience. The most common site of the perforation is at the level of the esophagogastric junction, and it occurs when the myotomy is extended onto the stomach.

However, it has been reported that esophageal perforations in achalasia cases can be managed with esophageal stenting after primary repair failure.