Living with Achalasia? Here is How Heller Myotomy Restores Safe Swallowing

Do you ever feel food or water getting stuck in your throat or chest when you eat? Do you sometimes feel afraid to eat because food refuses to go down smoothly? This frustrating and scary feeling might be caused by a rare medical condition called achalasia.

Living with this swallowing disorder is not easy every single day. Because swallowing is hard, you might not eat enough food, which can lead to poor nutrition and weight loss. Today, we are going to talk simply and clearly about a common surgical treatment for this condition called Heller Myotomy.

Key Takeaways

What Is Heller Myotomy?

Simply put, Heller Myotomy is a surgery used to treat a condition called achalasia. Achalasia is a rare disease that affects your esophagus, which is the muscular tube that carries food from your mouth down to your stomach. In achalasia, the normal movement that pushes food and liquids down stops working properly.

The word myotomy means cutting a muscle. During a Heller Myotomy surgery, your surgeon makes small cuts in a special ring of muscle at the bottom of your esophagus. Doctors call this ring of muscle the Lower Esophageal Sphincter, or LES for short. This tight valve sits right where your food pipe meets your stomach.

If you have achalasia, your LES muscle fails to relax and open properly. Because of this tight block, food and drinks cannot pass easily into your stomach. Heller Myotomy fixes this problem by relaxing and opening up that stubborn LES muscle so food can travel down with ease.

Doctors often perform this surgery along with another important step called a fundoplication. During this extra step, your surgeon wraps the top part of your stomach around the bottom of your esophagus. This smart wrapping helps prevent stomach acid from splashing back up into your throat.

The most important thing to remember is that Heller Myotomy is not a complete cure for achalasia. However, it provides wonderful, long-term relief from your daily symptoms. Even so, you might need additional treatments or procedures years down the road.

How to Prepare for Surgery

Before your surgery, your doctor will order a few routine tests to make sure you are healthy and ready. These tests often include blood work, a chest X-ray, and an electrocardiogram to check your heart health.

Your anesthesiologist will also speak with you before the procedure. They will ask you several important health questions:

• Have you ever had anesthesia before, and did you have any problems with it?
• What prescription medicines, over-the-counter drugs, or vitamins do you take daily?
• Do you smoke tobacco, drink alcohol, or use any recreational substances?

You must take several steps to prepare your body for surgery. Always talk openly with your doctor to confirm these preparation rules.

How the Surgery Is Performed

Now let us look at what happens inside the operating room during your procedure. Doctors usually perform this operation using a laparoscopic method. This means they use tiny instruments and a lighted camera to see inside your body without making a large open cut.

• First, your anesthesia doctor places an intravenous line in your arm to give you sleep medicine so you feel no pain.
• Next, your surgeon makes about five very small cuts in your belly area.
• Your surgical team then fills your belly cavity gently with carbon dioxide gas to create working space.
• The doctor inserts a tiny camera and miniature surgical tools through your small belly incisions.
• Using these specialized tools, the surgeon carefully cuts the outer muscle layer of your lower esophagus to relax the tight LES valve.
• Next, the surgeon performs the fundoplication step by wrapping a small part of your stomach around the esophagus to stop acid reflux.
• Finally, the surgeon removes the instruments and closes your tiny cuts with stitches.

This entire surgical procedure usually takes about two hours to complete.

What Happens After Surgery

Your recovery experience after surgery will be unique to you. However, most patients spend at least one night in the hospital for safe monitoring. During this time, nurses provide fluids and nutrition through your intravenous line.

Your esophagus may swell up a little bit right after surgery. This swelling can take up to two months to fully go away. Because of this healing process, you must change your diet gradually.

Your medical team will give you clear guidelines, but most patients follow a gentle, step-by-step eating plan.

Benefits and Risks of Heller Myotomy

Benefits

Many people try other non-surgical treatments for achalasia before turning to Heller Myotomy when those methods fail. The biggest benefit of this surgery is that it relieves your disruptive achalasia symptoms so you can eat comfortably again.

Recent clinical research reviews show that between 87% and 92% of patients experience lasting symptom relief after this operation. Even so, as we mentioned earlier, this surgery does not cure achalasia forever. Symptoms may slowly return five to ten years down the road.

Risks

Just like any major surgery, Heller Myotomy carries certain risks. Common surgical risks include heavy bleeding or wound infections. Other specific medical complications can include:

• Barrett’s esophagus, which is a change in the lining of your lower food pipe.
• Infections in or around your esophagus.
• Gastroesophageal Reflux Disease (GERD), where stomach acid flows upward.
• An accidental tear or rupture in your esophageal wall.

When to Call the Doctor

Heller Myotomy and POEM Surgery: What Is the Difference?

You may have also heard about another modern procedure called POEM. POEM stands for Peroral Endoscopic Myotomy. Just like Heller Myotomy, this treatment helps patients with achalasia.

The main difference between the two surgeries is how the doctor reaches your esophagus. During a POEM procedure, your doctor makes no cuts on your outer belly. Instead, your doctor inserts a flexible tube with a tiny camera called an endoscope through your mouth and down your esophagus. They cut the tight LES muscle from the inside. In contrast, Heller Myotomy uses tiny belly cuts to perform the muscle cut from the outside.