Laparoscopic Heller Myotomy for Achalasia (Swallowing Disorder)

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 esophageal muscles to become progressively weaker and actually cease to work at all. In addition, the lower esophageal sphincter never completely opens, 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 destroys 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 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 relieve any gastroesphageal reflux that may be caused by destroying the valve.

Are patients satisfied with the procedure?

Patients who have undergone this procedure at the Institute are followed yearly and have expressed satisfaction with the results of this operation.

What are the risks?

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. These complications all occur rarely and have not been encountered to date by our patients.

Minimally invasive surgeons who perform this procedure:

Washington University in St. Louis minimally invasive surgeons who treat gallbladder disorders:

Michael M. Awad, MD
L. Michael Brunt, MD
J. Christopher Eagon, MD