Heller Myotomy for Achalasia

What is achalasia?
Achalasia is a disorder of the esophagus characterized by a progressive inability to swallow solids and liquids.

The esophagus (food tube) has muscles that propel food from the mouth into the stomach. There is a valve (lower esophageal sphincter) between the esophagus and the stomach that opens to allow food to pass into the stomach and then closes to keep the stomach contents from refluxing up into the esophagus.

Achalasia causes the upper esophageal muscles to become progressively weaker and actually cease to propel the food at all. In addition, the lower esophageal sphincter never completely relaxes, so that food does not enter the stomach easily. These two problems cause increased difficulty in swallowing and may progress to vomiting, weight loss, malnutrition and dehydration.

How many people are affected by achalasia?
Achalasia affects five in every 100,000 adults nationwide.

How is achalasia treated?
A surgical procedure called the Heller myotomy has become the treatment of choice and offers long-term symptomatic relief to those who have the disorder.

This procedure weakens the muscles at the gastroesophageal junction, allowing the valve between the esophagus and stomach to remain open.

Although there is no definitive medical treatment, medical therapies may help to relieve the symptoms of achalasia in its early stages.

How is a laparoscopic Heller myotomy performed?
In laparoscopic Heller myotomy, a small incision is made just above the umbilicus. A trocar (hollow tube) is inserted, and the abdomen is filled with carbon dioxide gas to allow visualization of the abdominal organs. A scope with a light and camera is inserted into this trocar and the image is shown on TV monitors. Four more small incisions are then made and trocars are inserted to allow placement of the instruments used to perform the operation.

The esophagus and stomach are identified and freed from the surrounding tissue. The muscles of the esophagus and stomach are carefully divided for a distance of at least six centimeters up on the esophagus and down two centimeters on the stomach. Great care is taken to avoid cutting the inner lining. The opening of the muscles is called a myotomy.

The tip of the stomach is then wrapped around behind the esophagus (this is called a fundoplication) and sewn to the edges of the myotomy both to keep the myotomy open and to prevent any gastroesphageal reflux that may be caused by destroying the valve.

Are patients satisfied with the laparoscopic procedure?
Patients who have undergone this procedure are followed closely and have expressed satisfaction with the results of this operation.

What are the risks of Heller myotomy?
As with any operation, complications can occur. The possible complications of this operation include damage to the lung, spleen, stomach, esophagus or liver, or problems related to anesthesia. There could be postoperative infection, bleeding or problems from esophageal or gastic perforations. There are long-term risks of gradual return of the original symptoms, but this takes place over years and often over decades.

General thoracic surgeons who perform this operation:
Bryan F. Meyers, MD, MPH
Traves D. Crabtree, MD
Daniel Kreisel, MD, PhD
Alexander S. Krupnick, MD
G. Alexander Patterson, MD
Varun Puri, MD 

For a patient appointment with a general thoracic surgeon, please call (888) 287-8741 or (314) 362-6025.