LaparoscopicHellermyotomy is the mainstay surgical treatment of esophageal achalasia and has proven to be safe and effective over the course of time. Esophageal perforation after myotomy can be a serious complication with devastating outcomes. Most commonly, mucosal perforation is 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.
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