What is Heller Myotomy? Let's talk about it simply.

Do you feel a lump in your throat or chest when you eat or drink? Do you sometimes feel afraid to eat because it feels like your food is not going down? This could be due to a rare condition called Achalasia. Living with this condition is not easy. It is difficult to swallow food, and not eating properly can even lead to nutritional deficiencies. So today we are going to talk about a surgery called Heller Myotomy, which is performed as a treatment for this.

What is Heller Myotomy surgery?

Simply put, Heller Myotomy is a small incision surgery to treat Achalasia . Achalasia is a rare condition that affects our esophagus, or food pipe. This is when the process of sending food and liquids from the esophagus to the stomach does not work properly.

The word "myotomy" means to cut a muscle. In a Heller Myotomy, the surgeon makes several small cuts in a ring of muscle at the bottom of your esophagus, called the Lower Esophageal Sphincter (LES) . The LES is a thick muscle that sits between the lower part of your esophagus and the upper part of your stomach. It's like a valve.

If you have achalasia, the LES muscle doesn't open and close properly. This prevents food from passing from the esophagus into the stomach. Heller Myotomy surgery works by relaxing the LES muscle and opening it.

This surgery is often done in conjunction with another procedure called a fundoplication . This involves the surgeon taking a section of your stomach and wrapping it around your esophagus. This reduces the risk of stomach acid coming back up into your esophagus (reflux).

How do you prepare before surgery?

To make sure you are suitable for surgery, your doctor will order several tests before the surgery. For example, blood tests, a chest X-ray, and an ECG.

Before the surgery, the anesthesiologist who will anesthetize you will talk to you. They will ask you questions like:

• Have you had anesthesia before and how was the experience?
• What herbs, medications, or vitamins do you use?
• Do you use tobacco, alcohol, or other drugs?

There are a few things you need to do to prepare for surgery. These should be discussed and confirmed with your doctor.

How is the surgery done?

Now let's look at what happens inside the surgery. Most often, this is done laparoscopically . That is, with the help of a telescope. Here, the surgeon uses a thin instrument with a camera attached to it to look inside your esophagus and very small instruments to perform the surgery.

• First, the anesthesiologist will put an IV line (like a tube that gives saline) into a vein in your arm and give you medicine to put you to sleep. You won't feel anything during the surgery.
• Next, the surgeon will make about 5 very small incisions in your abdomen (tummy).
• Then, your abdominal cavity is filled with carbon dioxide gas. This is done to make it easier to move the surgical instruments and to provide a clear view of the esophagus and upper part of the stomach.
• Now the doctor inserts a camera and small surgical instruments through those incisions .
• Using these instruments, the muscle layer at the bottom of the esophagus is cut lengthwise and the LES is opened.
• Then, a procedure called fundoplication is performed. This involves taking a portion of the upper part of the stomach and wrapping it around the esophagus. This stops stomach acid from coming up.
• Finally, the camera and equipment are removed, and those small incisions are stitched up.

This entire surgery usually takes about two hours.

What happens after the surgery?

The experience after surgery can vary slightly from person to person. But typically, you will stay in the hospital overnight. During this time, you will be given fluids and nutrition through an IV line. After that, the recovery period begins.

Your medical team will explain this to you, but the usual diet plan is as follows.

What are the benefits and risks of this surgery?

Benefits

Many people with achalasia resort to Heller Myotomy when other non-surgical treatments fail. The main advantage of this procedure is that the symptoms of achalasia disappear after the surgery.

A recent analysis of research has shown that between 87% and 92% of people who have had this treatment have had their symptoms go away. However, as we have said before, this does not completely cure achalasia. Symptoms may sometimes recur 5-10 years after surgery.

Risks

As with any major surgery, Heller Myotomy has risks. General risks include excessive bleeding and infection. In addition, specific complications that can occur include:

• Barrett's esophagus
• Esophageal infections
• GERD (gastroesophageal reflux disease)
• Esophageal rupture

When to see a doctor

If you have any of the following symptoms after surgery, call your doctor immediately, or go to the Emergency Department (ETU) of the nearest hospital.

• If the surgical site is red and swollen.
• If pus is coming from the surgical wound.
• If you can't even swallow liquids.
• If the painkillers given by the doctor don't relieve the pain.

Difference between Heller Myotomy and POEM surgery

You may have also heard of a procedure called POEM. POEM is short for Peroral Endoscopic Myotomy . Like Heller Myotomy, this is also a treatment for the condition Achalasia.

The difference between the two is that in POEM surgery, no incisions are made in your stomach. Instead, your doctor inserts an endoscope (a tube with a camera attached) through your mouth and down your esophagus. The LES muscle is then cut open from the inside. In Heller Myotomy, this is done from the outside through small incisions in your abdomen.

Heller Myotomy Sinhala, Achalasia Treatment, Difficulty Swallowing, Esophageal Surgery, Laparoscopic Surgery, Fundoplication, Postoperative Diet