Heller myotomy is a surgical procedure used to treat achalasia, a relatively rare disorder affecting the esophagus.
Achalasia is characterised by the inability of the lower esophageal sphincter (LES) to relax properly, leading to
difficulties in swallowing, chest pain, and other gastrointestinal symptoms. The LES is a muscular ring that controls
the flow of food from the esophagus into the stomach.
The principal of Heller myotomy is to alleviate these symptoms by cutting the muscles at the LES to allow easier
passage of food. Traditionally, this surgery was done through an open incision in the abdomen or chest, but with
advancements in medical technology, it is now most commonly performed using a minimally invasive technique
known as laparoscopic Heller myotomy. In laparoscopic Heller myotomy, several small incisions are made in the
abdomen, and surgical instruments along with a camera are inserted to guide the surgery. This approach reduces
recovery time, minimises pain, and lowers the risk of complications compared to open surgery.
During the procedure, a careful incision is made through the muscle layers of the LES without damaging the inner
lining of the esophagus. This partial cut reduces the pressure at the LES, enabling easier swallowing. However,
because this procedure can increase the risk of gastroesophageal reflux disease (GERD), it is often accompanied by
a partial fundoplication. Fundoplication involves wrapping the top part of the stomach around the lower end of the
esophagus to create a new valve mechanism, thereby preventing acid reflux.
Patients undergoing Heller myotomy typically experience significant relief from dysphagia (difficulty swallowing) and
other achalasia-related symptoms. The success rate of the surgery is high, with many patients reporting a
substantial improvement in their quality of life. Heller myotomy represents a significant advancement in the treatment
of achalasia, offering patients a safe and effective option to relieve their symptoms and improve their ability to eat
and drink comfortably.
Postoperatively, patients may need to follow a specific diet temporarily and take medications to manage acid reflux if
it occurs. Regular follow-ups are necessary to monitor the outcomes and to address any complications or recurrence
of symptoms.