Heller’s Cardiomyotomy for Achalasia (Laparoscopic Scarless)

Laparoscopic Heller’s Cardiomyotomy, also known as Cardiomyotomy, is the most commonly used method to treat Achalasia Cardia.


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Achalasia Cardia

Achalasia cardia is a disorder of the esophagus also known as the food pipe. Achalasia means “failure to relax” and Cardia means upper end of stomach.

Normal swallowing is affected in this condition as the muscle around the lower end of the food pipe becomes abnormally thick.

Understanding Heller’s Cardiomyotomy

A sphincter is the muscle that relaxes to allow food to pass and remains narrow otherwise. In achalasia cardia this sphincter muscle becomes abnormally thick and tight causing difficulty swallowing. Heller’s cardiomyotomy provides a solution to this problem. In this procedure the thickened esophageal sphincter is cut, so as to allow easy passage of solids and liquids. But in the long run, this could be a problem in a way that allows excess gastric juices to reflux upward to the esophagus. To prevent this, the upper part of the stomach is taken and wrapped around the cut portion of the esophagus. This is known as the ‘Dor Procedure’. Heller’s procedure is minimally invasive and provides prompt recovery.

How is Hellers Cardiomyotomy Performed?

In this procedure, a single keyhole incision is made, and the esophagus is visually located using laparoscopic tools. A lengthwise cut is then made right above the LES, lower esophageal sphincter, extending partway to the stomach. The esophagus is made of several layers of muscles and only the outside layer, which causes the Esophagus to squeeze shut, is cut.

A partial fundoplication or “wrap” is then performed on the reaming lower portion of the esophagus and the upper part of the stomach, so as to prevent excessive reflux of the stomach acid, which can cause serious damage to the esophagus over time.

Hellers Cardiomyotomy

Treatment window

The only effective way to relieve the obstruction caused in the gullet, due to the contraction of the ring muscles in the gullet is to cut that specific muscle and free the obstruction. Hence, it better to get operated as soon as it is diagnosed.

life after HELLER’S CARDIOMYOTOMY

  • Strict follow up for at least weeks.
  • Not to lift heavy things.
  • Not to drive.
  • Avoid sexual relations for at least 2 weeks.

Heller’s Cardiomyotomy – FAQs

It is a congenital defect just as some people have bad heart valves or poorly developed limbs.
You are not able to swallow because the muscle at the lower end of your gullet has become abnormally tight, and has an inherent failure to relax.

This can be made to relax with drugs like calcium channel blockers or with pneumatic dilatation where a balloon is used to open up the lower end of the gullet or by actually splitting open the muscle laparoscopically (Laparoscopic Heller’s Myotomy) or POEM (Per oral Endoscopic Myotomy).
It depends upon patient, general condition, age, previous treatments and degree of disease. One needs to make a careful decision based on all these factors.

I tend to do this through 4 tiny incisions in the Abdomen, through which we access the abdominal cavity and expose the thickened tight muscle. Then I would carefully cut open the 2 layers of tightened muscle, to free the inner lining of the gullet known as the mucosa. We also do a per operative endoscopy to make sure that the lining has been properly freed.

Heller’s Cardiomyotomy Specialists

Dr. J. S. Rajkumar

CHIEF SURGEON

M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)


Dr. Prabhakaran Raju

Consultant Surgical Gastroenterolgy M.B.B.S., M.S (GENERAL SURGERY), Mch(SGE)

Dr. Anirudh Rajkumar

Bariatric and Laparoscopic Surgeon M.B.B.S., Dip.N.B. (GENERAL SURGERY).