Heller Myotomy for the Treatment of Achalasia

Achalasia

A Heller myotomy is a surgical procedure which is used to treat a condition called achalasia. This uncommon disorder affects the esophageal tract. A person with achalasia has a defect in their lower esophageal sphincter which prevents it from relaxing properly. This means the esophagus is unable to push food into the stomach. If the condition is not treated, the esophagus can become enlarged and may stop functioning altogether. In addition, people with an enlarged esophagus are at increased risk of esophageal cancer.

Around 1 in 100,000 people are affected by achalasia. The condition mainly affects young women, and men and women in middle age. Elderly people with chronic or recurrent respiratory infection may also develop achalasia.

Symptoms include difficulty swallowing, chest pain, heartburn, feeling of a lump in the throat, hiccups, and weight loss.

The Heller Myotomy

Achalasia can be treated with a variety of non-surgical methods including drug therapy, and a procedure called balloon dilation in which the constricted muscle is stretched. If these treatments fail to produce positive results, the Heller myotomy may be used as a treatment.

During surgery, the patient is under general anesthetic. The Heller myotomy is typically formed using a laparoscopic method that is minimally invasive and reduces recovery time. Once the incision is made, the esophageal sphincter is located. The muscle is cut so that it is no longer able to contract as tightly. With the muscle weakened, it will open more easily and allow food to pass through into the stomach.

Once the surgery is completed, patients have a hospital stay of one to four days, depending on whether the procedure was laparoscopic or open.

Risks and Complications

Possible post-operative complications and risks include infection and bleeding. Patients should watch for signs of infection such as fever, pain that gets worse, redness and swelling at the incision site, or fluid draining from the incision.

The Heller myotomy successfully relieves patient symptoms in up to 90% of cases. The effectiveness of the surgery decreases over time, however, with symptomatic relief in about 85% of cases after ten years, and 65% of cases after twenty years. Despite this, the procedure is the most effective permanent solution for achalasia.

References

Michael E. Debakey Department of Surgery at Baylor College of Medicine: Heller Myotomy

Pankaj J Parischa, MD. Patient Information: Achalasia

UCLA Center for Esophageal Disorders: Preparing for Heller Myotomy (Achalasia)