What is Laparoscopic Heller Myotomy

Laparoscopic Heller myotomy is a surgery to treat a disorder in which food cannot move from the esophagus into the stomach (achalasia). The esophagus is a muscular tube that moves food from the mouth to the stomach.

There is a bundle of muscles near the place where the esophagus meets the stomach (esophageal sphincter). Normally, after you swallow, the esophageal sphincter relaxes to allow food into your stomach. Achalasia occurs when these muscles do not relax after you swallow. This prevents food from getting into your stomach. During Heller myotomy, the esophageal sphincter muscles are cut to allow food to pass into the stomach.

Laparoscopic surgery is done using a thin tube that has a light and camera on the end of it (laparoscope). The camera sends images to a screen in the operating room, and these images are used to help guide the surgery. This type of surgery is done through small incisions, rather than one large incision.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Problems with food and stomach acid moving back up into the esophagus (gastroesophageal reflux disease, GERD).
• A hole (perforation) in the esophagus. This is often repaired right away with another surgery.
• Allergic reactions to medicines.

What happens before the procedure?

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care team what steps will be taken to help prevent infection. These may include:
  • Removing hair at the surgery site, if needed.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic).
• Your abdomen will be cleaned with a germ-killing solution (antiseptic).
• A small incision will be made in your abdomen.
• A small tube will be inserted into this incision, and your abdomen will be filled with air-like gas. This helps your surgeon see the area and provides more space for surgery to be performed.
• A laparoscope will be inserted into this incision.
• Several small incisions will also be made in your abdomen. Surgical instruments will be placed through those incisions to perform the surgery.
• Tight esophageal sphincter muscles will be cut.
• The gas will be released from your abdomen.
• Your incisions will be closed with stitches (sutures) and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will be given pain medicine as needed.
• You may given medicines to prevent nausea and vomiting (antiemetics).
• You will continue to have an IV until you are able to drink fluids.

Summary

• Laparoscopic Heller myotomy is a surgery to treat a disorder in which food cannot move from the esophagus into the stomach (achalasia).
• During surgery, the bundle of muscles where the esophagus meets the stomach (esophageal sphincter) is cut.
• Laparoscopic means that this procedure is done through small incisions, using a tube that has a light and camera on the end of it (laparoscope).
• After surgery, you will continue to have an IV until you are able to drink fluids.

Laparoscopic Heller Myotomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some discomfort when swallowing.
• Soreness in the abdomen.
• A full, tight, or painful feeling in the abdomen (bloating).

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions. You may need to eat only soft foods, such as yogurt and ice cream, for a period of time.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Go for a walk or get some physical activity one or more times a day. This can help to relieve bloating.
• Do not drive or use heavy machinery while taking pain medicine.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay incision healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have any of the following:
  • A fever.
  • Pain that does not go away with medicine.
  • Painful bloating.
  • Trouble swallowing.
  • Redness, swelling, or pain around an incision.
  • Nausea or vomiting.
• Notice that your incision area feels warm to the touch.
• Have symptoms of constipation, such as:
  • Fewer bowel movements in a week than normal.
  • Trouble having a bowel movement.
  • Stools (feces) that are dry, hard, or larger than normal.
• Have symptoms of food and stomach acid moving back up into your esophagus (gastroesophageal reflux disease, GERD), such as:
  • Heartburn.
  • Having an upset or bloated stomach.
  • A feeling of having a lump in your throat.
  • A bitter taste in your mouth.

Get help right away if:

• You have any of the following:
  • Vomiting that is severe or does not stop.
  • Severe bloating.
  • Fluid or blood coming from an incision.
  • Pus or a bad smell coming from an incision.
• You cannot swallow.
• You vomit blood.
• An incision opens up.
• You have trouble breathing.

Summary

• Check your incision area every day for signs of infection, such as redness or swelling.
• Follow instructions from your health care provider about eating or drinking restrictions. You may need to eat only soft foods, such as yogurt and ice cream, for a period of time.
• Contact your health care provider if you have nausea or vomiting.
• Make sure you know which symptoms should cause you to get help right away.