Name of the Procedure:

Esophagomyotomy (Heller type); abdominal approach

Summary

Esophagomyotomy (Heller type), performed via an abdominal approach, is a surgical procedure aimed at relieving difficulty in swallowing by cutting the muscles at the lower end of the esophagus.

Purpose

The procedure primarily addresses achalasia, a condition where the lower esophageal sphincter fails to relax properly, causing swallowing difficulties. The goal is to improve the passage of food from the esophagus to the stomach, thereby alleviating symptoms such as difficulty swallowing, regurgitation, and chest pain.

Indications

• Persistent difficulty swallowing (dysphagia)
• Regurgitation of undigested food
• Chest pain unrelated to heart conditions
• Failure of non-surgical treatments
• Confirmed diagnosis of achalasia through diagnostic tests like esophageal manometry or barium swallow

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to current medications as advised by the surgeon
• Pre-operative diagnostic tests like esophageal manometry, endoscopy, and barium swallow
• Pre-surgical evaluation and clearance

Procedure Description

1. Administration of general anesthesia.
2. The surgeon makes small incisions in the abdomen.
3. A laparoscope and specialized surgical instruments are inserted through these incisions.
4. The surgeon cuts the muscles at the lower end of the esophagus (the lower esophageal sphincter).
5. This allows the esophagus to more freely pass food into the stomach.
6. The incisions are then closed, often with sutures or surgical staples.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

The procedure is performed in a hospital or a specialized surgical center.

Personnel

• Surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection
• Bleeding
• Perforation of the esophagus or stomach
• Gastroesophageal reflux disease (GERD)
• Anesthesia-related complications

Benefits

• Significant relief from swallowing difficulties
• Reduced regurgitation of food
• Decreased chest pain related to achalasia
• Improved quality of life, with benefits often noticeable within a few days

Recovery

• Hospital stay for 1-2 days post-procedure
• Gradual return to normal diet starting with liquids then advancing to solids
• Pain management as needed, usually with oral pain relievers
• Avoiding strenuous physical activities for a few weeks
• Follow-up appointments to monitor progress

Alternatives

• Pneumatic dilation: non-surgical procedure to widen the lower esophageal sphincter
• Peroral Endoscopic Myotomy (POEM): a less invasive endoscopic procedure
• Botulinum toxin injections: temporary relief by relaxing the sphincter muscle
• Medication: nitrates or calcium channel blockers to reduce sphincter pressure

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-operative pain can be managed with oral painkillers. Discomfort from the incisions and altered eating patterns are common but typically improve within a few weeks. Regular follow-up helps ensure a smooth recovery and address any complications promptly.