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What is a Heller myotomy and why is it necessary?

Monday, July 19, 2010 @ 10:07 AM
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A Heller myotomy is a surgical procedure to treat achalasia, a condition in which the patient has problems swallowing food. When food arrives at the end of the esophagus, the muscular valve known as the lower esophageal sphincter (LES) fails to relax to allow food into the stomach. To treat achalasia, the muscle around the gastroesophageal junction must be cut to limit its ability to block the passage of food.

A Heller myotomy procedure can be performed through a large incision or through several small incisions using laparoscopic instruments. Since development of the laparoscopic procedure, recovery time has been reduced significantly.

Details of the procedure

What do I need to do before surgery?

Please contact your insurance company to verify the coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least five to ten days before the surgery date. Your surgeon will give you specific instructions on how to prepare for the procedure.

What happens on the day of surgery?

You will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all paperwork is in order. You will be taken to a pre-operative holding area, where an anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed.

What type of anesthesia will be used?

You will have a pre-operative interview with an anesthesiologist, who will ask you questions regarding your medical history. A Heller myotomy is performed with general anesthesia, which will keep you asleep during surgery.

What happens during the surgery, and how is it performed?

If your surgery is performed laparoscopically, your surgeon will make three to four small incisions, and insert tube-like instruments through them. The abdomen will be filled with gas to help the surgeon view the abdominal cavity. A camera will be inserted through one of the tubes that will display images on a monitor in the operating room. In this manner, your surgeon will be able to work inside your abdomen without making a larger incision.

Your surgeon will perform the Heller Myotomy procedure with the laparoscopic method unless other factors require open surgery. If performed with the open method, one larger incision will be made.

Once inside, the junction between the esophagus and stomach is found. A lengthwise incision is then made on the muscular ring surrounding the lower esophageal sphincter. Because the muscle is weakened, the LES is able to open more easily.

Your surgeon may perform an additional procedure to prevent reflux. This is often called a low-resistance fundoplication (link to Nissen Fundoplication procedure) in which the upper portion of the stomach is carefully wrapped around the esophagus.

What happens after the surgery?

Once the surgery is completed, you will be taken to a post-operative or recovery unit where a nurse will monitor your progress. It is important that your bandages be kept clean and dry. You will experience pain in your abdomen due to the rearrangement of the stomach, so your surgeon may perform a spinal epidural or prescribe pain medication.

How long will I be in the hospital?

Your length of stay will depend on your digestive behavior and your ability to tolerate physical activity. With the laparoscopic procedure, most patients remain in the hospital one or two days and two to four days with an open procedure.

What are the risks associated with a Heller myotomy procedure?

As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia.  Leakage from the esophagus is possible. Acid reflux may occur if the LES is relaxed too much or if the gastroesophageal junction is repaired too tightly, the pre-operative symptoms may remain. Your surgeon will inform you of the risks prior to surgery.

What should I watch out for?

Be sure to call your doctor if any of the following symptoms appear:
• Difficulty swallowing
• Fever
• Worsening pain
• Redness, warmth, or swelling around the incision
• Drainage from the incision

Will there be scar(s)?

If the procedure is performed laparoscopically the incisions should heal well, leaving small discrete scars. If the open method is used, a larger scar will be present.

When can I return to work and/or resume normal activities?

Patients are usually able to resume normal activities after two to three weeks. Your surgeon will give you specific instructions for recovery. If you are taking narcotic medications for pain, you should not drive.

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