A Heller Myotomy is the primary form of surgical treatment for achalasia, a motility disorder that makes it very difficult for patients to move food through their esophagus and into the stomach. Typically, the muscles in the lower part of the esophagus do not relax during mealtime, making it difficult to swallow food or liquid. Achalasia can cause patients significant distress and if left untreated, can lead to weight loss and malnutrition.
The Laparoscopic Heller Myotomy
The traditional form of Heller Myotomy is performed in a laparoscopic surgical manner. During the procedure, four tiny incisions are made in the abdomen through which specially made surgical devices are passed. Small incisions are made in the Lower Esophageal Sphincter or the LES, the primary valve that regulates the flow of food and liquid from the esophagus to the stomach. The procedure alleviates pressure by weakening the muscles in the esophagus.
The advances in laparoscopy allow for shorter hospital stays as well as fewer complications when compared to surgeries in the past.
The Endoscopic Heller Myotomy
The team at NYU Langone Long Island Surgical Associates was the first to perform a Heller Myotomy in a non-surgical, endoscopic manner back in 2009. Since then, we have become a leader in the minimally invasive and non-surgical treatment of achalasia.
The endoscopic approach eliminates the small incisions used in laparoscopy. Instead, a specially made device is passed through the mouth down the esophagus and the procedure is performed “from the inside.“
While the endoscopic Myotomy does not have as much clinical data behind it as the laparoscopic form, our initial results have shown even more promise in the resolution of the symptoms of achalasia. Not only do more than 90% of patients get complete relief, but the relief lasts. Further, as we have refined the endoscopic technique, it can now be performed on an outpatient basis for certain cases, which reduces patient downtime as well as costs. Serious complications have also been reduced with the endoscopic approach.
Risks and Considerations of Heller Myotomy
The laparoscopic approach to the Heller Myotomy has the same inherent risk profile as any minimally invasive procedure. These risks are discussed during consultation and can be minimized by employing highly experienced surgeons such as those at our practice. The greatest concern is the development or worsening of GERD after the procedure, which is often mitigated by performing a simultaneous Nissen Fundoplication.
The endoscopic approach eliminates many of the risks associated with surgery and significantly reduces patient downtime. However, because the procedure is performed endoscopically, a fundoplication cannot be performed at the same time. If patients develop severe reflux after the endoscopic Myotomy, they may have to undergo a further surgical procedure to correct that. However, as we have improved upon the endoscopic approach, the number of patients requiring intervention for GERD has decreased dramatically.