Return of achalasia symptons after surgery and what to do next?

It is not uncommon for fundoplications to need to be adjusted; the extent of how much of the circumference is involved in the original 'wrap' is a matter of surgical judgement, and it is not always possible to get this right first time.   The prospect of having  repeated stretches is not a good one, partly because it will tend to close off better surgical options.  

I am sorry that it did not work better and longer for you first time, but the best thing is to trust the judgement of the experienced surgeon about the next best step for you;  it is not unusual, and the surgery can normally be revised OK.

I agree about checking on the fundoplication with your surgeon.  Also, have you considered the POEM surgery?  I would check with your surgeon (or a POEM surgeon if your current surgeon doesn't perform this surgery) to see if that's a option that could help you.

Hi

I too had the exact same op in Ocxtober 2013 and I also had a worsening of my symptoms. I had a dilation under GA in May 2015 which did not make the slightest bit of difference. I have also found swallowing is a little beter since the original op and I have found a variety of foods I cannot swallow easily. I find the chunkier the food such a vegetables the easier it is to swallow but I really suffer with foods such as rice, pasta, crisps etc. All these foods seem to block me up. I now eat all meals with a hot drink such as tea which helps a lot. I saw my surgeon last week and we discussed the options. A previous barium swallow showed I still had a few muscle fibres which were causing the problem I am still experiencing but second or third time around it is a much more difficult operation as the surgeon has to undo the wrap and then cut through a lot of potential scar tissue from the first op. This increases the risk of perforation of the oesophagus which is not without its problems.  However there is not much else left. I am having a repeat barium swallow next week which I am sure will show a worsening of the narrow point at my oesophageal gastro valve ( or whats left of it) and I have told my surgeon, whatever the risks, I am prepared to go through it all again. I know that the statistics say that after a repeat myotomy 75% of patients show a noticable improvement in their symptoms. I did discuss the POEM (Per oral endoscopic myotomy) procedure but my surgeon said he did not think this was suitable at all given where my stricture is. It would be difficult to get to it using the POEM op but beside that he is not experienced in it and has doubts about its efficiency. On a good note I dont get any of the night time reflux I experienced pre myotomy and fundoplication. No more waking up choking which i did frequently so I am sure food is going down and the wrap works , its just it goes down too slowly. I have a totally aperistaltic oesophagus which means no contractions at all.Food and liquids go down by gravity ( ok that rules out a career as a spaceman). I think that all i can do is draw up a list of good foods and bad foods and avoid the bad like the plague and maybe drink more when I eat. Hope your symptoms resolve. Best thing is to go back to your surgeon and ask for a repeat myotomy.

My surgeon advised against a repeat myotomy. He explaned to me that the risks vs the rewards are not as good the second time around. Please let me be clear though everyone is different. My surgeon listed specific reasons why he did not want to repeat myotomy. I have had a pneumatic dilitation with little or no relief and botox with no relief. He stated that these are both indicators that my problem is more related to scar tissue than residual muscle fibers or tight fundiplication. Another evidence of this is that my myotomy and fundiplication are 15 years old and I had 80% relief for many years.