Laparoscopic Heller Myotomy

Laparoscopic Heller myotomy is a surgery to treat a disorder called achalasia. This disorder makes it difficult for food to move from the esophagus into the stomach. The esophagus is a muscular tube that moves food from the mouth to the stomach.

A bundle of muscles is located near the place where the esophagus meets the stomach (lower esophageal sphincter, LES). Normally, after you swallow, the LES muscles relax to allow food into your stomach. Achalasia occurs when these muscles do not relax after you swallow. This prevents food from getting into your stomach. During Heller myotomy, the LES muscles are cut to allow food to pass into the stomach.

Laparoscopic surgery is done using a thin tube that has a light and camera on the end of it (laparoscope). The camera sends images to a screen in the operating room, and these images are used to help guide the surgery. This type of surgery is done through small incisions, rather than one large incision.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

• Infection.
• Bleeding.
• Problems with food and stomach acid moving back up into the esophagus (gastroesophageal reflux disease, GERD).
• A hole (perforation) in the esophagus. This is often repaired right away with another surgery.
• Allergic reactions to medicines.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

• 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• Plan to have a responsible adult take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for the time you are told after you leave the hospital or clinic. This is important.
• Ask your health care provider what steps will be taken to help prevent infection. These steps may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Taking antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic).
• Your abdomen will be cleaned with a germ-killing solution (antiseptic).
• A small incision will be made in your abdomen.
• A small tube will be inserted into this incision, and your abdomen will be filled with air-like gas. This will help your surgeon see the area and will provide more space for surgery to be performed.
• A laparoscope will be inserted into this incision.
• Several other small incisions will also be made in your abdomen. Surgical instruments will be placed through those incisions to perform the surgery.
• Tight esophageal sphincter muscles will be cut.
• The gas will be released from your abdomen.
• Your incisions will be closed with stitches (sutures), skin glue, or adhesive strips and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will be given pain medicine as needed.
• You may be given medicines to prevent nausea and vomiting (antiemetics).
• You will continue to have an IV until you are able to drink fluids.

Summary

• Laparoscopic Heller myotomy is a surgery to treat achalasia, which is a disorder that makes it difficult for food to move from the esophagus into the stomach.
• During surgery, the bundle of muscles where the esophagus meets the stomach (lower esophageal sphincter) is cut.
• Laparoscopic means that this procedure is done through small incisions, using a tube that has a light and camera on the end of it (laparoscope).