Heller Myotomy

What is a Heller myotomy?

A Heller myotomy (my-Oh-tuh-me) is a minimally invasive surgery to treat achalasia. Achalasia is a rare esophageal disorder that affects your ability to swallow food and liquid. It develops when your esophagus doesn’t move food and liquid to your stomach like it should.

Living with achalasia isn’t easy. You may struggle to swallow food, a struggle that often leads to not eating enough so you develop malnutrition. A Heller myotomy is one of the ways your healthcare provider can help.

The term myotomy means to cut into a muscle. It’s a type of thoracic surgery. In a Heller myotomy, your surgeon makes small cuts in your lower esophageal sphincter (LES). Your LES is a thick muscle in the lower part of your esophagus and the upper part of your stomach.

If you have achalasia, your LES doesn’t open and close to let food and liquid move from your esophagus to your stomach. A Heller myotomy opens your LES. The procedure often involves a second step — Heller myotomy with fundoplication. In fundoplication, your surgeon wraps part of your stomach around your esophagus. This procedure reduces the chance that reflux from your stomach will flow into your esophagus.

Heller myotomy isn’t a cure for achalasia. The procedure provides long-term relief. But you may need to have another Heller myotomy later on.

How should I prepare for Heller myotomy?

Your surgeon may order pre-surgery tests to confirm you’re able to have surgery. Tests may include blood tests, chest X-ray and an electrocardiogram.

Your anesthesiologist will meet with you before surgery. They’ll ask about:

• Your previous experience with general anesthesia
• If you take any herbal supplements, medication or vitamins
• If you use other drugs, tobacco or alcohol

There are some things you should do to get ready for surgery, including:

• Stop using nicotine. Nicotine in any form, including e-cigarettes, affects your blood flow and makes it hard for your body to heal after surgery.
• Fast. For example, your surgeon may say you can’t eat anything for six hours or more before surgery. You may be able to drink clear liquids for a certain amount of time before surgery. But be sure to double-check with your surgeon.
• Plan for your hospital stay. Heller myotomy is a major surgery. You’ll probably be in the hospital for at least one day after your surgery. You should also plan on having someone available to take you home and stay with you during the first 24 hours.
• Plan for your recovery. You may take prescription pain medication after your surgery, which means you’ll need someone to act as your driver until you stop taking pain medication.

What happens during a Heller myotomy?

Nearly all Heller myotomies are laparoscopic surgeries. Your surgeon will use a thin telescopic rod with a camera on the end to view your esophagus and small surgical tools to do the surgery. Here’s what would happen during your surgery:

1. Your anesthesiologist will insert an intravenous (IV) line in your arm to give you medication that puts you to sleep. You’ll be unconscious during surgery, and you won’t feel any pain.
2. Your surgeon will make five small incisions (cuts) in your belly.
3. They’ll fill your abdomen with carbon dioxide. This makes it easier for them to move surgical tools and gives them a clear view of your esophagus and upper stomach.
4. Your surgeon will insert a small, lighted camera and small surgical tools through the incisions.
5. They’ll make a lengthwise cut into the muscular layer in the lower part of your esophagus to open your lower esophageal sphincter.
6. Your surgeon will pull part of your stomach up and wrap it around your esophagus. This step is a fundoplication. This creates a valve to keep reflux from flowing from your stomach into your esophagus.
7. They’ll remove the camera and tools from your abdomen and close the incisions.

A laparoscopic Heller myotomy with fundoplication typically takes about two hours to complete.

What happens after a Heller myotomy?

Everyone’s experience is a bit different. In general, however, you’ll stay in the hospital overnight. You may receive fluids and nutrition via an IV line. Next comes recovery. Your esophagus will be swollen for as long as two months and your gut needs time to heal. That means some changes in what you eat. Your care team will explain what you can expect, but here are some typical guidelines:

• Day 1 and Day 2. You’ll have clear liquids like chicken and beef broth, Jell-O®, ice pops and water.
• Day 3 through Day 7. You’ll start getting nutrition from dairy like ice cream, strained cream soup and cooked cereals like cream of wheat or cream of rice.
• Day 8 until your two-week checkup. You’ll move to soft foods. Your surgeon will explain when you can start adding solid food to your meals.

What are the benefits of having a Heller myotomy?

Most people with achalasia have a Heller myotomy when nonsurgical treatments aren’t effective. The main benefit is that a Heller myotomy typically eliminates achalasia symptoms.

One recent analysis of research shows the procedure eliminated symptoms in 87% to 92% of people receiving treatment. That said, Heller myotomies don’t cure achalasia. Often, achalasia symptoms come back within five to 10 years after surgery.

What are the risks or complications of Heller myotomy?

Like any major surgery, Heller myotomy complications may include excessive bleeding and infection. Other potential complications are:

• Barrett’s esophagus
• Esophageal infection
• GERD
• Esophageal rupture

What is the recovery time?

It may take about two months for swelling in your esophagus to go away so food can move to your stomach. After two months, you may be able to add different kinds of foods to your meals. You may still want to continue some of the habits you developed while living with achalasia. For example, you should still:

• Cut your food into small, bite-size pieces and chew it thoroughly
• Take sips of water while you eat to moisten your food and make it easier to swallow
• Sit up when you eat and stay upright for about 30 minutes after you eat

When can I get back to my daily routine?

You can go back to your routine as soon as you feel like it and you aren’t taking prescription pain medication. That includes driving or going to work or school. Gentle activities like taking walks will help your recovery, but talk to your surgeon before you start new activities or routines.

When should I call my healthcare provider?

Call your provider or go to the nearest emergency room if:

• There’s redness and swelling at the surgery site
• There’s pus coming from the surgery site
• You can’t swallow liquids
• Prescription pain medication doesn’t ease pain

What’s the difference between a Heller myotomy and a POEM procedure?

POEM stands for peroral endoscopic myotomy. Like Heller myotomy, it’s a treatment for achalasia. The difference between the two is that in a POEM procedure, your healthcare provider doesn’t make any cuts in your abdomen. Instead, they place an endoscope into your mouth and down into your esophagus. This opens the lower esophageal sphincter from the inside.