University of California San Francisco

Heller Myotomy

The Heller myotomy is a  laparoscopic (minimally invasive) surgical procedure used to treat achalasia. Achalasia is a disorder of the esophagus that makes it hard for foods and liquids to pass into the stomach.

The Heller myotomy is essentially an esophagomyotomy, the cutting the esophageal sphincter muscle, performed laparoscopically.

The operation's success rate is very high and usually permanent. A small number of patients may need addtional treatment.

Description of Procedure

In the procedure, several tiny incisions are made and a small scope inserted, through which miniature surgical instruments are passed. The scope is connected to a video camera which then sends a magnified image to a monitor, allowing the surgeon to envsion the anatomy and manipulate the instruments..

The advantages of the Heller myotomy include:

  • Less post-operative pain
  • A 1-2 day hospital stay vs. up to a week with a conventional open procedure
  • Faster recovery from surgery
  • A more rapid return to work and normal activities

Nissen Fundoplication

Many patients develop gastroesophageal reflux disease (GERD) after a Heller myotomy. To avoid the development of the condition where contents of the stomach reflux (back up) into the esophagus, a Nissen fundoplication is may be performed at the same time the esophageal sphincter muscle is cut.

This procedure, alsoperformed  laparoscopically, involves wrapping the upper part of the stomach  around the lower esophegeal sphincter to strengthen it.