Name of the Procedure:

Esophagomyotomy (Heller type); thoracic approach

Summary

Esophagomyotomy, commonly known as Heller myotomy, is a surgical procedure that involves cutting the muscles at the lower end of the esophagus to help food pass more easily into the stomach. The thoracic approach involves accessing the esophagus through the chest.

Purpose

The procedure is primarily used to treat achalasia, a condition where the esophagus has difficulty moving food to the stomach due to tight muscles. The goal is to relieve symptoms like difficulty swallowing, chest pain, and regurgitation of food.

Indications

• Diagnosis of achalasia confirmed via diagnostic tests.
• Symptoms such as severe difficulty swallowing (dysphagia), chest pain, regurgitation, or weight loss.
• Failure of symptomatic relief from other treatments like medications or balloon dilation.

Preparation

• Fasting for 8 hours prior to the procedure.
• Discontinuation of certain medications as directed by your healthcare provider.
• Pre-operative diagnostic tests including esophageal manometry, barium swallow, and endoscopy.
• Pre-surgical consultations with the surgical team and anesthesiologist.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made between the ribs to access the esophagus.
3. The esophageal muscles are carefully cut from above the stomach to allow the lower esophageal sphincter to relax.
4. If necessary, a partial fundoplication may be performed to prevent reflux.
5. The incision is sutured closed, and surgical drains are placed if needed.

Duration

The procedure typically takes 2 to 3 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Surgical nurses
• Anesthesiologist
• Surgical assistants
• Post-operative care team

Risks and Complications

• Common: Infection, bleeding, and temporary difficulty swallowing.
• Rare: Esophageal perforation, reflux esophagitis, pneumonia, and adverse reactions to anesthesia.

Benefits

The expected benefits include significant relief from symptoms of achalasia, improved ability to swallow, and enhanced quality of life. Benefits are typically realized within a few weeks post-surgery.

Recovery

• Hospital stay typically lasts 1 to 3 days.
• Gradual reintroduction to a normal diet starting with liquids and soft foods.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor recovery and address any issues.
• Pain management with prescribed medications.

Alternatives

• Pneumatic dilation: Less invasive but may require repeat procedures.
• Medications: Provide temporary relief.
• Peroral Endoscopic Myotomy (POEM): Minimally invasive and endoscopic in nature.
  Each alternative has its pros and cons regarding effectiveness, risks, and recovery time.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-surgery, mild to moderate pain at the incision site can be expected, which will be managed with pain medications. Patients may feel some discomfort and will need to follow specific dietary restrictions as they recover.