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Procedure Name

Heller Myotomy
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Surgery Type

Closed (Laparoscopy)
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Hospital Stay

1 to 2 days
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Duration of Surgery

3 to 4 hours
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Type of Anesthesia

General Anesthesia
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Full Recovery

6 to 8 months

Overview

The surgical approach of cutting the cardia (lower esophageal sphincter or LES) to allow foods and liquids to pass to the stomach is known as Heller Myotomy. It is a laparoscopic procedure most often used to treat a rare disorder known as achalasia, in which the LES fails to relax normally, making it difficult for food and liquids to reach the stomach. 

Earlier, the surgery was performed traditionally through an open approach, either through the chest (thoracotomy) or abdomen (laparotomy), but with the revolutionary advancement in the field of medicine, it has been substituted by a laparoscopic approach. This article will discuss in detail Heller Myotomy, its indications, procedure, benefits, and potential risks involved in the surgery.

What is Heller Myotomy?

Introduced in the year 1913 by Ernst Heller, this procedure aims to correct the abnormality occurring in the esophagus (food pipe connecting the throat to the stomach), where the muscles of the LES (lower esophageal sphincter) are cut, thereby allowing the food and liquids to pass into the stomach. LES is a ring of muscles at the bottom of the esophagus that allows food and liquids to pass into the stomach. Heller myotomy is often used to treat achalasia, a disorder that prevents the LES from relaxing and allowing food and liquids to pass into the stomach. Heller myotomy is done laparoscopically and uses a special medical device known as a laparoscope, a thin, long, flexible tube with a tiny camera and a light source at the end. This camera helps capture images internally and projects them on a large screen, guiding the surgeon in performing the surgery. Heller myotomy is a minimally invasive procedure, meaning minimal trauma and bleeding are involved during the surgery, with a quick recovery rate.

When is Heller Myotomy Recommended?

Heller myotomy is a surgical treatment recommended for achalasia. It is a condition when the muscles at the lower part of your esophagus do not allow food to enter your stomach. This occurs due to the damaged and injured nerves around your esophagus that prevent normal functioning, resulting in dysphagia (trouble swallowing), chest pain, heartburn, malnutrition, and considerable weight loss. If achalasia is left untreated, there may be a risk of developing esophageal cancer. Hence, surgeons recommend a Heller Myotomy, a minimally invasive laparoscopic surgery to treat achalasia.

How to Prepare For a Heller Myotomy?

Your surgeon may discuss the procedure with you to understand your expectations from the surgery. 

  • Your surgeon will ask about your medical history to rule out conditions such as diabetes (increased blood sugar levels), hypertension (high blood pressure), and other disorders that may alter the outcome of the procedure.
  • You must inform your surgeon about any allergies or previous history of surgery.
  • You will be advised to discontinue medications like blood thinners (eg: aspirin) and other herbal supplements if any 1 to 2 weeks before the procedure to prevent bleeding during or after surgery.
  • You will be asked to quit smoking and alcohol 1 to 2 weeks before the procedure as it may delay wound healing.
  • Since the procedure will be done under general anesthesia, you must avoid eating or drinking from midnight before the surgery to prevent vomiting or aspiration of food into the lungs. 
  • You should arrange for someone to stay in the hospital after the surgery as you will need help with your activities.

How is Heller Myotomy Performed?

Heller Myotomy is a minimally invasive procedure that may require you to stay in the hospital for 1 to 2 days. The procedure usually takes 3 to 4 hours to complete. 

  • You will be made to lie flat on the procedure table, where you will be given general anesthesia through IV (intravenous) infusion. This will sedate and puts you to sleep during the entire procedure.
  • Your surgeon will make 5 keyhole-sized (around 2cm) incisions (cuts) above your umbilicus (belly button), and the abdomen will be filled with gas (carbon dioxide) to help inflate the abdomen. This provides a clear view of the surgical site. 
  • A special instrument known as a laparoscope will be inserted through one incision, and a surgical instrument through other incisions.
  • Your surgeon will divide the muscle layers in the esophagus to locate and access the hardened layer (outer layer, which is squeezing the esophagus shut) of tissues and make small cuts (myotomy) to relieve the pressure. The inner mucosal layer is left intact.
  • Furthermore, the Heller Myotomy Fundoplication procedure is performed to prevent the risk of GERD (gastroesophageal reflux disorder) after the surgery. Here the tissues from the fundus (upper end of your stomach) will be wrapped around and behind your esophagus. 
  • The tiny multiple incisions are closed with small stitches that can be resorbed.

What to Expect After a Heller Myotomy?

After the surgery, you will be kept in the recovery room and can expect the following:

  • Your vitals, like BP (blood pressure), sugar levels, pulse, heart rate, urine output, and oxygen levels, will be monitored.
  • You may experience mild pain and discomfort when you regain consciousness, which can be managed through pain relief medications.
  • You will be given fluids through IV infusions to keep you hydrated.
  • A special type of X-ray, barium esophageal, will be performed the next day to check if fluids are passing through the esophagus.
  • A light semi-solid diet may begin the next day, depending on how well you can take in liquids.
  • You will be sent home 1 to 2 days post-surgery.
  • Consume soft foods for the next 2 weeks, avoid bread for 6 to 8 weeks (as it may stick), and permanently avoid carbonated drinks.
  • Recovery will take around 3 to 4 weeks, but it may take 6 to 8 months for your esophagus to heal completely.

What Are The Benefits And Risks of Heller Myotomy?

Heller myotomy is a safe and effective procedure that helps relieve symptoms of achalasia that offers several benefits as an alternative to open surgery:

Benefits

  • Provides relief from dysphagia and acid reflux and improves your quality of life.
  • Less pain after the surgery, which can be easily managed through pain medications.
  • Shorter hospital stay (1 to 2 days).
  • Less scarring due to small incisions or cuts made around the umbilicus.
  • Quick recovery with minimal postoperative complications.
  • Quick return to work and other routine activities.
  • Additional relief from GERD through fundoplication procedure performed during the Heller Myotomy surgery.

Risks

As with any surgical procedure, Heller Myotomy poses the following risks post-operatively:

  • Esophagitis (infection in your esophagus) that leads to high-grade fever (>104?), chills, or body aches, with or without pus discharge.
  • Accidental perforation (puncture) or tearing of the inner lining of your esophagus.
  • Increased risk of esophageal cancer.
  • Barrett's esophagus (a condition in which the mucosal lining of the esophagus is damaged by persistent acid reflux) thickens the lining abnormally).

Why choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!

The power of Medfin in patient’s words

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“ Got to know about them from my friend. They got an appointment for only 299. Once the doctor confirmed that I needed the surgery they got me a fixed cost which included ALL the costs. No extra amounts were charged. Thank you Medfin”

Suresh Menon Hyderabad 8 days ago
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“ After my consultation with the doctor, MEDFIN representative got me a fixed package cost that included my mothers initial tests, surgery cost. They also gave me stockings free for Rs. 3000 post the surgery. They kept up their promise they made”

Radhika Iyer Mumbai 8 days ago
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