378. LAPAROSCOPIC PRIMARY CLOSURE OF ESOPHAGEAL RUPTURE CAUSED BY BALLOON DILATATION FOR ACHALASIA AND HELLER'S MYOTOMY WITH DOR FUNDOPLICATION

Abstract Background Achalasia is a Primary motor disorder of the esophagus cased by Insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Major clinical presentations are Dysphagia, regurgitation, and occasional chest pain with or without weight loss. One of most commonly performed conservative treatment is pneumatic dilatation and its most serious complication is esophageal perforation. In this presentation we will introduce a case of esophageal perforation caused by pneumatic dilatation for esophageal achalasia treated with laparoscopic primary closure of perforation and simultaneous Heller’s myotomy with Dor Fundoplication. Methods Esophageal perforation occurred during endoscopic pneumatic dilatation occurred in 61-year-old female patient with achalasia. Initially endoscopic clipping was performed but the patient showed leukocytosis, tachycardia and decreased oxygen saturation with dyspnea. Chest CT showed intraabdominal and mediastinal free air and defect in distal esophagus. Then the patient was referred for surgery. During laparoscopic exploration, 3cm mucosal and 6cm muscle tearing at distal esophagus 2cm proximal to the esophagogastric junction at 3 o’clock direction. After removal of endoscopic clips, primary closure of esophageal rupture in 2-layed method and simultaneous Heller’s Myotomy with Dor fundoplication at 12 o’clock direction was performed. Results The patient showed rapid recovery from septic condition. Nasogastric tube was removed 4 days after surgery. Upper GI series checked with gastrografin 5 days after surgery showed no leakage and no delayed passage in distal esophagus. Chest tube and abdominal drain were removed and the patient was discharged 10 days after surgery. There was no dysphagia and reflux during follow-up afterwards. Conclusion Primary closure for esophageal rupture occurred during balloon dilatation for achalasia and simultaneous Heller’s myotomy with Dor fundoplication by approaching the esophagus from a different direction were successfully performed reducing not only the risk of fulminant sepsis but also the burden of the surgery for achalasia that would be needed to be performed later.