We present a 55-year-old female with class II obesity and a previous history of sleeve gastrectomy who developed significant gastroesophageal reflux disease refractory to medical management. After a covid infection in fall of 2020 she began to report new symptoms of dysphagia that progressed from solids to liquids. She underwent extensive workup including upper endoscopy, upper GI barium swallow, manometry, pH impedence and EndoFlip leading to a diagnosis of Achalasia type II as well as a paraesophageal hernia.


Given these findings she underwent a combined paraesophageal hernia repair with conversion of sleeve gastrectomy to Roux-en-Y gastric diversion and an intra-operative Peroral Endoscopic Myotomy.


The patient tolerated the procedure well and recovered with improvement of both her reflux and achalasia.