Minimally invasive surgeons are treating achalasia of the esophagus using the minimally invasive Heller Myotomy technique. Benefits of this approach include five small incisions instead of one large abdominal incision, shorter hospital stay, reduced postoperative pain and a shorter recovery time of a few days.
Laparoscopic cardiomyotomy (Heller myotomy) is performed for achalasia. Achalasia is a primary esophageal motility disorder of unknown etiology. It is characterized by progressive loss of peristalsis in the body of the esophagus and failure of a normal or hypertensive lower esophageal sphincter (LES) to relax upon swallowing. No form of treatment returns the esophageal peristalsis or the LES function back to normal. Instead, therapy is aimed at relieving the functional obstruction at the gastroesophageal junction.
Patients with achalasia present with progressive dysphagia and weight loss. Pain is uncommon. The diagnostic workup must exclude several diseases that can mimic achalasia.
There are several therapeutic options once achalasia is definitively diagnosed. Patients who can tolerate general anesthesia are candidates for laparoscopic cardiomyotomy. Pneumatic balloon dilation is an alternative treatment. Botulinum toxin (BOTOX) injection is an alternative that should be reserved for patients who are not candidates for operation or dilatation.
Because patients with achalasia frequently retain food and secretions within the esophagus, preoperative fasting for at least 8 hours is recommended. Candida albicans frequently colonizes this dilated esophagus and preoperative oral antifungal therapy may be warranted. These measures decrease the likelihood of aspiration upon induction of anesthesia, and minimize the consequences of inadvertent mucosal perforation during myotomy.
Cardiomyotomy for achalasia is one of the ideal procedures for the laparoscopic approach. Magnification of the operative field during laparoscopic surgery allows for a precise division of the muscle fibers with excellent results. Over the past several years, numerous reports of laparoscopic cardiomyotomy have been published. They show good-excellent results, with relief of dysphagia in 90-97% of patients, with minimal morbidity, a short hospital stay and early return to routine activity.