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Laparoscopic Heller Myotomy with Dor Fundoplication for Achalasia

A minimally invasive antireflux surgical procedure for esophageal achalasia in which the muscle fibers of the lower esophageal sphincter are divided (Heller myotomy) and a partial anterior 180-degree fundoplication (Dor) is added to control reflux while preserving swallowing.

Written by: Saygı Hospital Health Guide Editorial Board
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This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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What is Laparoscopic Heller Myotomy with Dor Fundoplication for Achalasia?

Achalasia is a primary esophageal motility disorder characterized by failure of the lower esophageal sphincter to relax and absent peristalsis of the esophageal body, leading to dysphagia, regurgitation, weight loss, and chest pain.

Laparoscopic Heller myotomy involves longitudinal division of the circular and longitudinal muscle fibers of the distal esophagus and proximal stomach for 6 to 7 cm above and 2 to 3 cm below the gastroesophageal junction, while preserving the underlying mucosa.

An anterior 180-degree Dor fundoplication is added to reduce postoperative reflux without recreating an obstacle to swallowing; long-term symptom relief at 10 years is reported in 85 to 90 percent of patients, comparable to per-oral endoscopic myotomy (POEM) but with lower postoperative reflux.

Symptoms

Progressive dysphagia for both solids and liquids over months to years
Regurgitation of undigested food, particularly at night, with risk of aspiration
Substernal chest pain or non-cardiac chest pain associated with meals
Significant weight loss and nutritional deficiency in advanced disease
Heartburn that does not respond to acid suppression
Recurrent aspiration pneumonia in untreated long-standing achalasia

Risk Factors

Type II achalasia (best outcomes with both myotomy and POEM)
Type III spastic achalasia (longer myotomy required)
Failure or recurrence after pneumatic dilation or botulinum toxin injection
Sigmoid esophagus or megaesophagus in advanced disease (technically more complex)
Younger age and lower comorbidity burden, favoring surgical over endoscopic treatment

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Progressive dysphagia and regurgitation in a patient referred from gastroenterology with confirmed achalasia on manometry
  • Recurrent symptoms after botulinum toxin or pneumatic dilation
  • Megaesophagus with severe weight loss and aspiration risk
  • Postoperative new severe heartburn or regurgitation — endoscopy and pH testing
  • Suspected recurrence with new onset dysphagia after Heller myotomy — repeat manometry and timed barium esophagram

Treatment Methods

01
Preoperative work-up: high-resolution manometry to classify achalasia subtype, timed barium swallow to assess esophageal emptying, and upper endoscopy to exclude pseudoachalasia
02
Laparoscopic 5- or 6-port approach with hiatal dissection, esophageal mobilization, and identification of vagus nerves
03
Heller myotomy of 6 to 7 cm proximal and 2 to 3 cm distal across the gastroesophageal junction, with intraoperative endoscopy to confirm completeness and absence of mucosal perforation
04
Anterior 180-degree Dor fundoplication anchored to the right and left crura and to the cut myotomy edges
05
Postoperative liquid then soft diet for 4 to 6 weeks, dietary education, and long-term follow-up with periodic endoscopy and timed barium studies; consideration of POEM versus revisional Heller for recurrence

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.