Heller Myotomy

A Heller myotomy is a type of minimally-invasive procedure (small incisions of 2–3 inches long / general anesthesia) used to treat achalasia. Achalasia is a disorder of the esophagus that makes it hard for foods and liquids to pass into the stomach. The lower esophageal sphincter (LES), a valve located at the end of the esophagus, stays closed during swallowing, resulting in the back up of food. There is no cure for achalasia, but it can be managed with treatment and medical therapy.

How to prepare for Heller myotomy procedure

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
  • Radiation exposure, especially for those that are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any body piercings on your chest or abdomen

Other suggestions

  • Have liquids the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home
  • Remove all makeup and nail polish
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before Heller myotomy procedure

To determine whether you need this procedure, your doctor might perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during Heller myotomy procedure

A Heller myotomy will typically take 3 to 4 hours to complete. This procedure is typically performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
  • Usually, your doctor will administer general anesthesia (make you feel sleepy).
  • Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • Your doctor will proceed to make several small incisions above your belly button.
  • Through these incisions, your doctor will insert a video camera and specialized instruments.
  • During the procedure, your doctor will precisely divide the muscle layers in your esophagus to access stiffened tissue and make small cuts in it (myotomy) to relieve pressure.
  • To keep your myotomy open and to lower your risk for gastroesophageal reflux (GERD) after surgery, your doctor may also wrap tissue from the upper end of your stomach (fundus) around and behind your esophagus (Heller myotomy fundoplication).
  • The doctor will close up the incision(s) with stitches or staples, and you will be moved to the recovery area.

What to expect after Heller myotomy procedure

After the surgery, you will be taken to a recovery room for 24 to 48 hours. Other recommendations include:

General guidelines

  • The next day we perform a special X-ray test to examine your esophagus while you drink a special liquid.
  • You may need to eat a diet of soft foods while your esophagus heals.
  • The breathing tube is removed when you wake up from anesthesia.
  • Ambulation is started on the first or second day of surgery.
  • Urine catheters and drainage tubes (chest tubes) are removed after 24 to 72 hours.
  • You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
  • Your doctor will give you instructions to follow during your recovery.

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