Laparoscopic repair of esophageal perforation following pneumatic dilatation for achalasia: a case series

Abstract Pneumatic dilation for achalasia is an effective treatment but carries a risk of esophageal perforation, a rare yet serious complication. We report two cases of esophageal perforation following pneumatic dilation for achalasia, both successfully managed using a laparoscopic transabdominal approach. The first was a 33-year-old woman who developed chest pain and dyspnea immediately after dilation, with imaging confirming a distal esophageal perforation and left pleural effusion. The second was a 30-year-old man who presented with chest pain two hours post-procedure, with computed tomography revealing a localized periesophageal fluid collection. Laparoscopic exploration identified full-thickness tears near the gastroesophageal junction, which were repaired primarily. Dor fundoplication, pleural drainage, and feeding jejunostomy were performed in both cases. Both patients tolerated the procedures well. Laparoscopic management is a safe and effective option for esophageal perforation after pneumatic dilation in carefully selected patients, particularly when the perforation is distal and diagnosed early.