Laparoscopic Heller Myotomy

Laparoscopic Heller Myotomy

The esophagus (food pipe) passes food from mouth to stomach. A valve in the esophagus called lower esophageal sphincter (LES), located at the junction of stomach and esophagus, allows passage of food to stomach, and prevents backflow of stomach acid into esophagus.

Achalasia and gastroesophageal junction outflow obstruction (EGJOO) are two rare conditions where the lower esophageal sphincter fails to relax during food swallowing. Thus, food and liquids get stuck in the esophagus and patients report difficulty swallowing, also known as dysphagia.

Both achalasia and EGJOO are chronic and progressive diseases. Most patients, especially in the early stages of disease, present with heartburn rather than dysphagia. It is very important to differentiate between gastro-esophageal reflux disease (GERD) and achalasia or EGJOO because treatment is different.

High resolution esophageal manometry, an outpatient test performed by Dr. Darido, confirms the diagnosis of both achalasia and EGJOO.

There are 3 types of achalasia:

Type 1 achalasia shows complete absence of esophageal motility and a persistently high-pressure area at the level of the non-relaxing lower esophageal sphincter.

Type 2 achalasia shows a non-relaxing lower esophageal sphincter and pan-esophageal pressurization. The same pressure is found throughout the esophagus at the same time.

Type 3 achalasia is characterized by diffuse esophageal spastic contractions in addition to a non-relaxing lower esophageal sphincter.

Treatment for both achalasia and EGJOO aims at relaxing the tight lower esophageal sphincter to facilitate swallowing. Laparoscopic Heller myotomy and Toupet Funoplication is the traditional surgical procedure to relax the tight lower esophageal sphincter muscle. Surgery is performed under general anesthesia and through tiny incisions. The thick outer muscle tissue between the esophagus and stomach is cut open. This is followed by a partial fundoplication (wrapping the stomach around the esophagus) to prevent acid reflux.  Surgery allows food and liquid to pass easily into stomach. More than 90% of patients report resolution and improvement in their symptoms.

Other modalities for achalasia and EGJOO treatment include:

  • Endoscopic balloon dilation of the lower esophageal sphincter
  • Endoscopic Botox injection of the lower esophageal sphincter
  • POEM procedure or Endoscopic lower esophageal sphincter excision.

With each procedure, the desired outcome must be balanced with risks, side effects, and durability.

Is Heller Myotomy surgery appropriate for you?

At Houston Heartburn and Reflux Center, each patient receives a thorough evaluation for heartburn and acid reflux. Depending on your condition, Dr. Darido will recommend the appropriate treatment that suits you best. Achalasia is a chronic and progressive condition and treatment is tailored accordingly.

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