The Heller Myotomy is a surgical procedure used to treat Achalasia. Although there is no definitive medical treatment, medical therapies may help to relieve the symptoms of Achalasia in its early stages.
Achalasia causes the esophageal muscles to become progressively weaker and actually cease to work at all. In addition, the lower esophageal sphincter never completely opens, so that food does not enter the stomach easily. These two problems cause increased difficulty in swallowing and may progress to vomiting, weight loss, malnutrition and dehydration.
The Heller Myotomy has become the treatment of choice and offers long-term symptomatic relief to those who have the disorder.
THE PROCEDURE
This procedure destroys the muscles at the gastroesophageal junction, allowing the valve between the esophagus and stomach to remain open.
During laparoscopic Heller Myotomy, a small incision is made just above the umbilicus.
A trocar (hollow tube) is inserted, and the abdomen is filled with carbon dioxide gas to allow visualization of the abdominal organs.
A scope with a light and camera is inserted into this trocar and the image is shown on TV monitors. Four more small incisions are then made and trocars are inserted to allow placement of the instruments used to perform the operation.
The esophagus and stomach are identified and freed from the surrounding tissue.
The muscles of the esophagus and stomach are carefully divided for a distance of at least six centimeters up on the esophagus and down two centimeters on the stomach.
Great care is taken to avoid cutting the inner lining. The opening of the muscles is called a myotomy. The stomach is then wrapped around behind the esophagus (this is called a fundoplication) and sewn to the edges of the myotomy both to keep the myotomy open and to relieve any gastroesphageal reflux that may be caused by destroying the valve.
The Heller Myotomy Surgery Advantages
Results are different for each procedure and each patient. Some common advantages of minimally invasive colorectal surgery are:
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for Heller Myotomy procedure.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Before surgery
You will need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep.
Your work up before having Heller myotomy will include an upper endoscopy to look directly at the esophagus and stomach and take any biopsies, if necessary.
A swallowing study (x-ray study) is also needed to show if the esophagus is narrowed at its lower end and the condition of the esophagus above the area of narrowing.
You will also have a study that evaluates the ability of the esophageal muscles to push food toward the stomach, and the ability of the LES to relax when you swallow. This is called manometry and involves placing a small catheter lined with pressure sensors down your esophagus. This is done by our Gastroenterologist, specializing in gastrointestinal disease and endoscopy.
You should not eat or drink anything after midnight the evening before your surgery.
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
RECOVERY AFTER SURGERY
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.
Hospital discharge and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning. While you are recovering in the hospital, your nurse will demonstrate how to care for your stoma. You will also receive instructions and be coached through the process of managing your stoma for after your return home.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here:
Activities
Patients are encouraged to engage in light activity while at home after surgery.
Post operative pain is generally mild although some patients may require prescription pain medication.
Anti-reflux medication is usually not required after surgery.
You may shower after 48hrs (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. You will be able to shower in the hospital after 48hrs as well. Your nursing staff can assist you if needed. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least two weeks post-op.
You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
After discharge from the hospital, avoid lifting more than 10 pounds for 2-4 weeks and excessive bending or twisting for 1-2 weeks following surgery.
Avoid driving until you no longer need narcotic pain medication and you feel you can make rapid movements unimpaired by pain. Driving while taking narcotics can impair your ability to drive safely.
You should be able to return to work in 1-2 weeks. If your job involves heavy lifting and light duty is not an option, you may need up to 4 weeks off work to recover.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Diet & Bowel Care
Following achalasia surgery, you will be given specific diet instructions and be seen by a nutritionist.
Call your surgeon right away if you have:
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.