Laparoscopic Heller's Cardiomyotomy

Laparoscopic Heller's cardiomyotomy 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. The procedure involves making several small incisions in the abdomen and using a laparoscope (a thin, lighted tube with a camera) to visualize the area.

Indications

The primary indication for Laparoscopic Heller's cardiomyotomy is achalasia, which can cause symptoms such as:

• Dysphagia (difficulty swallowing)
• Regurgitation of food
• Chest pain
• Weight loss

Procedure

The procedure typically involves the following steps:

1. The patient is placed under general anesthesia and positioned on the operating table.
2. Several small incisions (usually 3-4) are made in the abdomen, and a laparoscope is inserted through one of the incisions.
3. The surgeon uses the laparoscope to visualize the lower esophageal sphincter (LES) and the upper portion of the stomach.
4. An incision is made in the muscular layer of the LES, extending onto the upper portion of the stomach (cardia).
5. The muscle fibers are carefully cut, allowing the LES to relax and improving the passage of food into the stomach.
6. Some surgeons may also perform a partial fundoplication (wrapping the upper portion of the stomach around the lower esophagus) to prevent gastroesophageal reflux disease (GERD).
7. The incisions are closed, and the patient is taken to the recovery room.

Benefits

Laparoscopic Heller's cardiomyotomy offers several benefits, including:

• Minimally invasive approach, resulting in smaller incisions and less tissue damage
• Reduced postoperative pain and discomfort
• Shorter hospital stay (usually 1-2 days)
• Faster recovery time (usually 1-2 weeks)
• Improved symptoms of achalasia, with significant improvement in dysphagia and regurgitation

Risks and Complications

As with any surgical procedure, Laparoscopic Heller's cardiomyotomy carries some risks and complications, including:

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

Postoperative Care

After the procedure, patients typically follow a soft food diet for several weeks to allow the esophagus and stomach to heal. Patients may also be prescribed medications to manage symptoms such as acid reflux or pain.

Long-term Outcomes

Laparoscopic Heller's cardiomyotomy has been shown to be an effective treatment for achalasia, with significant improvement in symptoms and quality of life. Studies have reported:

• High success rates (80-90%) in improving dysphagia and regurgitation
• Low complication rates (<10%)
• Improved long-term outcomes, with some studies reporting sustained symptom improvement at 5-10 years postoperatively