The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Laparoscopic Heller Myotomy

Definitive surgical treatment for achalasia: division of the lower oesophageal sphincter.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

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

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Laparoscopic Heller Myotomy?

Heller myotomy is a longitudinal division of the muscle layers of the distal oesophagus and proximal stomach, leaving the mucosa intact, that relieves the functional obstruction of achalasia.

The laparoscopic approach has become standard since the 1990s, replacing the open thoracic and abdominal techniques, with shorter hospital stay and faster recovery.

An anti-reflux procedure (Dor anterior or Toupet posterior partial fundoplication) is added to reduce the risk of postoperative gastro-oesophageal reflux disease.

Symptoms

Indications: confirmed achalasia (types I, II, III on high-resolution manometry)
Indications: failure or contraindication to endoscopic balloon dilatation or POEM
Indications: young patients preferring durable single intervention
Indications: symptomatic recurrence after botulinum toxin or balloon dilatation
Symptoms benefiting: progressive dysphagia for solids and liquids, regurgitation, chest pain, weight loss
Contraindications: severe end-stage achalasia (sigmoid oesophagus may need oesophagectomy)
Contraindications: oesophageal carcinoma must be excluded before surgery

Risk Factors

Mucosal perforation risk (1-5%) recognised intraoperatively and repaired immediately
Postoperative gastro-oesophageal reflux disease (5-15%, lower with partial wrap)
Recurrent dysphagia from incomplete myotomy or fibrosis (5-10%)
Trocar-related injuries (vascular, bowel) inherent to laparoscopy
Pulmonary complications in patients with chronic aspiration

When to See a Doctor?

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

  • Patients with progressive dysphagia, regurgitation and weight loss should be evaluated for achalasia
  • Confirmed achalasia patients need consultation with an experienced foregut surgeon
  • Persistent or worsening dysphagia after endoscopic therapy warrants referral for myotomy
  • Postoperative chest pain, fever or sudden dyspnoea suggests perforation and is an emergency
  • Long-term follow-up with annual endoscopy is recommended (small risk of squamous cell carcinoma in long-standing achalasia)

Treatment Methods

01
Preoperative workup: high-resolution oesophageal manometry, barium swallow, upper endoscopy
02
General anaesthesia, supine French position with steep reverse Trendelenburg
03
Five-port laparoscopic technique with division of the gastrohepatic ligament and exposure of the gastro-oesophageal junction
04
Myotomy length: 6 cm proximal on the oesophagus and 2-3 cm distal on the stomach (anterior wall)
05
Intraoperative endoscopy or air leak test to confirm completeness and exclude perforation
06
Add Dor (anterior 180°) or Toupet (posterior 270°) partial fundoplication for reflux prophylaxis
07
Postoperative care: liquid diet day 1, soft diet day 2-7, normal diet from week 2; 1-2 day hospital stay

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Genel Cerrahi Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Appendicitis

Genel Cerrahi

Appendicitis is inflammation of the appendix causing severe pain in the lower right abdomen. Early diagnosis and surgical treatment are life-saving.

Inguinal Hernia

Genel Cerrahi

Inguinal hernia is the protrusion of intestine or fat into the inguinal canal due to weakness in the abdominal wall. It can be permanently corrected with surgical treatment.

Umbilical Hernia

Genel Cerrahi

Umbilical hernia manifests as a soft swelling around the navel. While it often resolves spontaneously in infants, surgical treatment may be required in adults.

Gallstones and Cholecystectomy

Genel Cerrahi

Gallstones cause severe pain in the upper right abdomen, especially after fatty meals. They are safely treated with laparoscopic cholecystectomy.

Hemorrhoids (Piles)

Genel Cerrahi

Hemorrhoids result from swelling of the veins in the anus; they present with blood on toilet paper, itching, and pain. Various treatments are available, from lifestyle changes to surgery.

Anal Fissure

Genel Cerrahi

Anal fissure is a tear in the thin skin of the anal canal. It presents with sharp pain and bleeding and can be healed with medical or surgical treatment.

Pilonidal Sinus

Genel Cerrahi

Pilonidal sinus consists of tunnels and tracts prone to chronic infection, formed by hair becoming embedded under the skin in the tailbone area. Surgical treatment provides a permanent solution.

Thyroid Surgery

Genel Cerrahi

Thyroid surgery involves the removal of part or all of the thyroid gland for indications such as benign nodules, goiter, and thyroid cancer.

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.