Laparoscopy, Surgical, Esophagomyotomy (Heller Type), with Fundoplasty, when Performed

Name of the Procedure:

• Common Name: Laparoscopic Heller Myotomy with Fundoplasty
• Medical Term: Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty

Summary

Laparoscopic Heller myotomy with fundoplasty is a minimally invasive surgery to treat achalasia, a condition that affects the ability of the esophagus to move food toward the stomach. It involves cutting the muscles at the lower end of the esophagus to allow food to pass more easily into the stomach, with an additional step to prevent reflux.

Purpose

• Medical Condition: Achalasia or esophageal motility disorders
• Goals: Relief of swallowing difficulties, prevention of aspiration, and improvement of overall esophageal function. The addition of fundoplasty helps prevent gastroesophageal reflux post-surgery.

Indications

• Patients experiencing severe dysphagia (difficulty swallowing)
• Regurgitation of food or saliva
• Chest pain related to esophageal issues
• Diagnosed through tests such as esophageal manometry and barium swallow that confirm achalasia

Preparation

• Fasting: Typically, no food or drink after midnight before the procedure.
• Medication Adjustments: Certain medications may need to be paused.
• Diagnostic Tests: Esophageal manometry, endoscopy, and barium swallow are often performed.

Procedure Description

1. Anesthesia: Performed under general anesthesia.
2. Incisions: Small incisions are made in the abdomen for the laparoscopic instruments.
3. Myotomy: Surgical instruments are used to carefully cut the esophageal muscles at the gastroesophageal junction.
4. Fundoplasty: The top of the stomach (fundus) is wrapped around the esophagus to create a valve mechanism preventing acid reflux.
5. Closure: Incisions are closed with sutures or surgical staples.

Duration

• Typically lasts between 2 to 3 hours.

Setting

• Performed in a hospital or specialized surgical center with equipped laparoscopic facilities.

Personnel

• Surgeons specialized in gastrointestinal or laparoscopic surgery
• Anesthesiologists
• Operating room nurses
• Surgical technologists

Risks and Complications

• Common Risks: Infection, bleeding, and adverse reactions to anesthesia.
• Rare Risks: Esophageal perforation, recurrence of symptoms, postoperative reflux, and complications from fundoplasty.

Benefits

• Significant improvements in swallowing and reduction in regurgitation.
• Many patients experience immediate relief of symptoms.
• Minimally invasive approach results in shorter recovery time and less postoperative pain.

Recovery

• Post-procedure Care: Patients may need to stay in the hospital for a few days.
• Instructions: Diet typically starts with liquids and gradually progresses to solids.
• Recovery Time: Most patients can resume normal activities within 2-4 weeks.
• Follow-up: Regular monitoring and follow-up appointments are essential.

Alternatives

• Medications: Nitrates or calcium channel blockers for symptom relief.
• Botulinum Toxin Injections: Temporary relief but less effective long-term.
• Pneumatic Dilation: Non-surgical stretching of the lower esophagus.
• Pros and Cons: Medication and injections offer less invasive options but may not provide long-term relief. Pneumatic dilation is effective but has a higher risk of recurrence.

Patient Experience

• During Procedure: General anesthesia ensures the patient is asleep and pain-free.
• After Procedure: Some pain or discomfort at the incision sites, managed with pain medication.
• Pain Management: Oral or intravenous pain relief as needed. Most discomfort subsides within a few days.
• Comfort Measures: Gradual diet progression to minimize discomfort and ensure healing. Activities are typically limited during initial recovery.

The described procedure aims to significantly improve quality of life for patients suffering from debilitating esophageal conditions, with a relatively quick return to daily activities.