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surgery for achalasia after bariatric surgery
I had bariatric surgery almost 5 years ago (subtotal gastrectomy only) and shortly afterward discovered that it seems to have "unmasked" achalasia. I surmise that I had this condition since birth, with repeated hospitalizations for removal of objects that got stuck in my esophagus until age 11 when I had a dilation and symptoms subsided enough that I did not have to be hospitalized again...still occasionally choked on food but eventually it passed through. The condition was never explained to me probably because of my age when most events happened.
When I decided to have bariatric surgery I even requested the surgeon dilate a esophageal stricture, which he did during the surgery. Subsequently I have had worsening achalasia symptoms, have seen motility specialist and got the diagnosis and started to learn more. Without going in to more details, it has become necessary for me to have surgery to correct the achalasia. My question is what special considerations are there for me having a Heller myotomy, since I have virtually no stomach remaining (just a 60 or so cc tube-stomach). Are there very many instances of this surgery being done after subtotal gastrectomy? What problems might arise (above and beyond normal surgically related problems). Are there any case series of people in my situation in the medical literature that I might read? Would my potential outcome or risk be substantially different from someone with a "normal" stomach?
Am I asking the right questions? Are there other questions I should be asking when I find a potential surgeon? Is there someone in the San Francisco bay area with substantial expertise in both bariatric surgery and the GI surgery I need?
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