Is Heller Myotomy a Major Surgery?

An open Heller myotomy is a procedure to cut some muscles in the lower esophagus to improve swallowing ability.

Heller myotomy is a surgical procedure that corrects achalasia, a condition that makes swallowing difficult (dysphagia). 

Achalasia is a grave problem that affects your food pipe (esophagus). A ring-shaped muscle known as lower esophageal sphincter (LES)—present between the lower end of the esophagus and stomach—normally allows the food or liquid to pass through your esophagus into your stomach. 

When the LES becomes tight, the food—instead of passing easily through your esophagus into your stomach—keeps getting stuck in the esophagus. As a result, you may have trouble swallowing and problems like heartburn.

Open Heller myotomy involves cutting the outer muscles of the lower end of the esophagus through a large incision in the abdomen. This procedure relaxes the LES to improve your swallowing ability.

Generally, Heller myotomy is done in patients with achalasia who:

• Fail to get relief from medicines
• Opt for surgery and are fit for it

Heller myotomy can be done in any of the two ways, open or laparoscopic. The laparoscopic method involves making few, small incisions in the abdomen and then a laparoscope, a long tube that has a camera at front, is inserted to locate the LES and perform the surgery.

Though the laparoscopic method is preferred over the open approach for Heller myotomy, the open procedure is performed when:

• The patient has out-pouching of the esophagus above the LES (epiphrenic diverticula)
• The patient has a history of a previous failed Heller myotomy
• There is another abdominal problem that cannot be addressed with laparoscopy

• You will be asked to undergo a test that measures the muscle strength of your esophagus (manometry)before the surgery.
• You will be put on a clear liquid diet for 48 hours before the surgery.
• Heller myotomy is usually done early in the morning. Hence, you need to have an empty stomach for at least six to 12 hours before the surgery.

• General anesthesia makes you sleep throughout the surgery.
• A large incision will be made through the midline of your upper abdomen.
• The surgeon will retrieve the esophagus and cut it lengthwise starting above the LES and extending a little down onto the stomach.  
• Only the outer muscles of the esophagus will be cut, which will loosen the tight LES, thereby allowing its easy opening.
• The surgery usually takes two to four hours.

• You may be allowed to take liquids on the same day or a day later after a Heller myotomy. 
• You may start eating a soft food diet after two to three days. 
• You will be discharged within three to seven days after open Heller myotomy.
• Based on how well you tolerate foods, you can resume your normal diet, including raw fruits, within four to six weeks.
• You may have to take a month off work to recover from an open Heller myotomy . 
• You will be allowed to do heavy lifting only after six weeks or more.

Open Heller myotomy is major surgery with  a long recovery period. It also carries a risk of esophagus rupture (perforation) during the surgery. Other possible complications of Heller myotomy include:

• Gastroesophageal reflux disease (GERD): Food mixed with acidic juices gets pulled up in the esophagus from the stomach leading to heartburn
• Peptic strictures: Development of extreme narrow passages in the esophagus
• Persistent dysphagia: Persistent difficulty in swallowing