Laparoscopic Heller Myotomy

Laparoscopic Heller myotomy is a minimally invasive surgical procedure used to treat achalasia, a rare swallowing disorder characterized by the inability of food to pass through the esophagus and into the stomach.

Overview of the Procedure

The procedure involves making several small incisions in the abdomen, through which a laparoscope (a thin, lighted tube with a camera) and surgical instruments are inserted. The surgeon then locates the lower esophageal sphincter (LES), which is the muscle that separates the esophagus and stomach.

Steps of the Procedure

1. The patient is given general anesthesia to ensure they are comfortable and pain-free during the procedure.
2. The surgeon makes several small incisions in the abdomen, typically 3-4, through which the laparoscope and surgical instruments are inserted.
3. The surgeon locates the lower esophageal sphincter (LES) and carefully dissects the muscle fibers to release the constriction.
4. An anterior myotomy is performed, where the muscle fibers of the LES are cut to allow for easier passage of food into the stomach.
5. In some cases, a partial fundoplication may be performed to prevent gastroesophageal reflux disease (GERD) symptoms.
6. The incisions are closed, and the patient is taken to the recovery room to recover from anesthesia.

Benefits of Laparoscopic Heller Myotomy

The benefits of laparoscopic Heller myotomy include:

• Minimally invasive, resulting in smaller incisions and less scarring
• Reduced post-operative pain and discomfort
• Faster recovery time compared to open surgery
• Improved symptoms of achalasia, with significant improvement in swallowing function
• Low risk of complications, such as infection or bleeding

Risks and Complications

As with any surgical procedure, there are risks and potential complications associated with laparoscopic Heller myotomy, including:

• Bleeding or hemorrhage
• Infection
• Adhesions or scar tissue formation
• Gastroesophageal reflux disease (GERD) symptoms
• Esophageal perforation

Post-Operative Care and Recovery

After the procedure, patients typically spend several hours in the recovery room before being discharged home. Post-operative care and recovery may include:

• A liquid diet for several days to allow the esophagus to heal
• Avoiding heavy lifting or strenuous activities for several weeks
• Follow-up appointments with the surgeon to monitor progress and remove any sutures or staples
• Medications to manage pain, nausea, or GERD symptoms

Long-Term Outcomes

Laparoscopic Heller myotomy has been shown to be an effective treatment for achalasia, with significant improvement in swallowing function and quality of life. Long-term outcomes may include:

• Improved symptoms of achalasia, with significant reduction in dysphagia
• Reduced risk of esophageal dilation or rupture
• Improved nutrition and weight management
• Reduced risk of GERD symptoms and complications