The oesophagus (food tube) passes food from the mouth to the stomach. A valve in the oesophagus called the lower oesophageal sphincter (LES), located at the junction of the stomach and oesophagus, allows the passage of food to the stomach and prevents the backflow of stomach acid into the oesophagus.
Achalasia is a condition that causes weakening of the upper oesophageal muscles and prevents complete relaxation of the LES, making passage of food and liquids into the stomach difficult. These problems create difficulty swallowing and can lead to weight loss, malnutrition, vomiting and dehydration.
Heller myotomy is a surgical procedure to open the tight sphincter muscle (LES) by cutting the thick outer muscle tissue between the oesophagus and stomach. This is usually followed by a partial fundoplication to prevent reflux following the surgery. The surgery allows food to pass easily into the stomach.
You will have to be on a liquid diet for 3-4 days before the procedure in order to clear the oesophagus completely.
Heller myotomy can be performed by a minimal invasive laparoscopic approach or an open approach. The procedure will be performed under the effect of general anaesthesia. Your surgeon will make one long incision (of 6-10 inches or more) for an open surgical approach, or five to six small incisions for a laparoscopic approach on your upper abdomen. For the laparoscopic approach, your surgeon will insert tiny instruments and a laparoscope (a thin tube with a lighted device and a camera at the end to view the internal organs on a screen) through the small incisions.
Steps involved in Heller Myotomy procedure:
- Your surgeon will make a lengthwise incision in the food tube, from just above the LES to slightly into the stomach tissues. Only the outer muscles of the oesophagus will be cut, leaving the inner mucosal layer untouched. The incisions will reduce the force of the contracting muscles and relax the LES; thereby, allowing food to pass easily.
- This however, makes it easy for the stomach acid to enter up into the oesophagus. Hence, a fundoplication is often performed along with myotomy.
- To perform the fundoplication, your surgeon will wrap the upper part of your stomach around the LES, like a collar, to strengthen it.
- Myotomy and fundoplication together will allow entry of food into the stomach and at the same time prevent the acid from refluxing back into the oesophagus.
Following the procedure, you may be discharged after a day if you have undergone a laparoscopic surgery or after several days in the case of an open surgery. You may be advised to consume liquids and a soft food diet for a month. After fundoplication, you may be instructed to change your eating habits for a few months to help in the healing of the created oesophageal valve.
Medications will be given for pain relief. Avoid strenuous activities, heavy lifting and driving for at least 2 weeks after surgery. Inform your doctor immediately if you experience fever over 101°F, nausea or vomiting for 24 hours, constipation or diarrhoea for over 48 hours, or swelling, redness and odorous drainage from the incisions.
Risks and Complications
As with any procedure, Heller Myotomy involves potential risks and complications. They include:
- Damage to the oesophagus, liver, stomach, spleen or lungs
- Infection and bleeding
- Perforations of the gastric or oesophageal mucosal layer
- Recurrence of gastroesophageal reflux disease (GERD)
- Recurrence of original achalasia symptoms