Why patients with scleroderma and refractory gerd can't undergo partial wrap fundoplication? and patients with primary achalasia(e.g. type i)can undergo partial wrap fundoplication after heller's myotomy? both have absent peristal.(risk of dysphagia?

Scleroderma: In Scleroderma, the immune system causes your body to make too much collagen causing thickened skin/connective tissue. This happens anywhere there is microtrauma (joints, skin, etc) The reason why surgery is contraindicated in Scleroderma is because of the potential for creating more thickened tissue at the scar site which could be problematic internally.