Laparoscopic Heller's cardiomyotomy and Roux-En-Y gastric bypass for missed achalasia diagnosed after laparoscopic sleeve gastrectomy.

s@nu Morbidly obese patients are increasingly being referred for bariatric surgery, which includes 3 common techniques: laparoscopic gastric banding (LAGB), Roux-en-Y gastric bypass (LRYGB) ,and sleeve gastrectomy (LSG). Esophageal dysmotility and disorders of the lower esophageal sphincter (LES) are also well documented in morbidly obese patients, with gastroesophageal reflux disease (GERD) being a common co-morbidity from low LES pressures [1]. Achalasia in morbidly obese patients has been reported to be 1%, and this group of patients tends to be asymptomatic or present with atypical symptoms [2]. However, achalasia arising after bariatric surgery is uncommon. To our knowledge, achalasia detected after LSG has not been previously reported.