Laparoscopic Surgery for Achalasia

In patients who have achalasia, the muscle of the esophagus does not move in a coordinated fashion (aperistalsis), and the lower esophageal sphincter muscle does not relax in response to swallowing. Therefore, most patients have difficulty in swallowing both liquids and solid food (dysphagia). Frequently, there is associated weight loss and malnutrition. Regurgitation of undigested food from the esophagus can lead to pulmonary problems, including pneumonia. There are three potential treatments, including injection of Botox into the lower esophageal sphincter, dilation of the lower esophageal sphincter, or surgical division (myotomy) of the sphincter. Your physician will help you decide on the proper treatment for you.

What is Laparoscopic Surgery for Achalasia?

Division of the lower esophageal sphincter muscle (Heller myotomy) is the most definitive treatment for this disorder. It can be accomplished using laparoscopic technology. The laparoscope is a fiberoptic telescope that is connected to a high-resolution video camera. The laparoscope is inserted into the abdominal cavity through a small (1/2 inch) incision near the belly button. The image is projected onto a television monitor that your surgeon can view in the operating room. Four other small incisions (1/4 inch) are made to insert the small specialized surgical instruments to perform the procedure. The muscle at the lower end of the esophagus is divided for approximately 3 inches. The top portion of the stomach is wrapped partially around the esophagus to help prevent reflux after the procedure. The small incisions are closed with tape, and they are covered with Band-Aids.

What Can I Expect After the Surgery?

After about two hours in the recovery room, the patient is transferred to the surgical floor. The patient is given clear fluids when awake and encouraged to walk as soon as possible. Patients notice an immediate improvement in swallowing the night of surgery. Pain medication by mouth is given as needed. A limited barium swallow x-ray is taken after surgery to ensure the proper positioning of the procedure. Solid food is begun the day after the barium swallow. Discharge is also on the first postoperative day, and most patients return to normal activities within 10 days of the surgery.

What Can I Expect After the Surgery?

• There are five small incisions instead of a large abdominal incision and scar.
  
• Significantly less pain following surgery.
  
• Shorter hospital stay.
  
• Quicker return to normal activities.

Am I a Candidate for Laparoscopic Surgery for Achalasia?

Your physician can best advise you of the appropriate treatment for this disease. However, if surgery is recommended, it is preferable to use laparoscopic technology. The results of laparoscopic treatment are the same as for traditional surgery, if an experienced laparoscopic surgeon performs this complex procedure.