Laparascopic Heller Myotomy Surgery

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

Achalasia is a rare condition 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, as well as vomiting and food regurgitation. Achalasia is a chronic and progressive disease. Some patients, especially in the early stages of achalasia, present with heartburn and reflux symptoms. It is very important to differentiate between gastro-esophageal reflux disease (GERD) and achalasia because treatment is different.

High resolution esophageal manometry, an outpatient test performed by Dr.  Darido, classifies achalasia into 3 types:

  • 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.

The treatment for achalasia aims at relaxing the tight lower esophageal sphincter to facilitate swallowing. Heller myotomy is the traditional surgical procedure to open the tight lower esophageal sphincter muscle. The 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 reflux following the surgery.  The surgery allows food and liquid to pass easily into the stomach. 90% of patients report resolution or improvement in their symptoms.

Other modalities for achalasia 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.

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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.