Esophageal Perforations after Forceful Dilatation in Achalasia

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Abstract
The reported incidence of esophageal perforation after forceful diatation in achalasia is between 1-5%. Over the past 9 years 5 patients with this complication were treated. After demonstrating the perforation with a Gastrografin swallow, a left posterolateral thoracotomy is made. The full-thickness laceration is sutured in 2 layers. A Heller esophagocardiomyotomy is then performed on the contralateral side of the esophagus. The muscular layer on either side of the esophagocardiomyotomy is mobilized well so as to allow easy closure of the outer muscular layer of the esophagus in the area of the laceration. There were no deaths and minimal morbidity in these 5 patients, and functional results were excellent. Perforations of the esophagus after dilatation in achalasia should be operated on promptly and undergo closure of the laceration with a complimentary esophagocardiomyotomy.