25:
218:, starting usually about 6 cm above the lower esophageal sphincter and extending down onto the stomach approximately 2-2.5 cm. The oesophagus is made of several layers, and the myotomy only cuts through the outside muscle layers which are squeezing it shut, leaving the inner mucosal layer intact. This procedure can also be performed robotically.
242:) is laid over the front of the oesophagus and stitched into place so that whenever the stomach contracts, it also closes off the oesophagus instead of squeezing stomach acids into it. In Toupet or posterior fundoplication, the fundus is passed around the back of the oesophagus instead. Nissen or complete
264:
within 2–3 days, and return to a normal diet after one month. The typical hospital stay is 2–3 days, and many patients can return to work after two weeks. If the surgery is done open instead of laparoscopically, patients may need to take a month off work. Heavy lifting is typically restricted for
226:
There is a small risk of perforation during the myotomy. A gastrografin swallow is performed after the surgery to check for leaks. If the surgeon accidentally cuts through the innermost layer of the esophagus, the perforation may need to be closed with a stitch.
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Though this surgery does not correct the underlying cause and does not eliminate achalasia symptoms, the vast majority of patients find that the surgery greatly improves their ability to eat and drink. It is considered the definitive treatment for achalasia.
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Food can easily pass downward after the myotomy has cut through the lower oesophageal sphincter, but stomach acids can also easily reflux upward. Therefore, this surgery is often combined with partial
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techniques, which minimize risks and speeds recovery significantly. The 100th anniversary of Heller's description of the surgical treatment of patients with achalasia was celebrated in 2014.
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It was first performed by Ernst Heller (1877–1964) in 1913. Then and until recently, this surgery was performed using an open procedure, either through the chest (
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may also be useful to monitor changes in the tissue of the oesophagus, since reflux may damage the oesophagus over time, potentially causing the return of
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1004:
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This is a somewhat challenging operation, and surgeons have reported improved outcomes after their first 50 patients. An author search at
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The Heller myotomy is a long-term treatment, and many patients do not require any further treatment. However, some will eventually need
1203:
427:
Fisichella, P. Marco; Patti, Marco G. (October 2014). "From Heller to POEM (1914-2014): a 100-year history of surgery for
Achalasia".
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Richards, William O.; Torquati, Alfonso; Holzman, Michael D.; Khaitan, Leena; Byrne, Daniel; Lutfi, Rami; Sharp, Kenneth W. (2004).
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191:). However, open procedures involve greater recovery times. Modern Heller myotomy is normally performed using
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Richardson, William S.; Carter, Kristine M.; Fuhrman, George M.; Bolton, John S.; Bowen, John C. (July 2000).
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276:. It is important to monitor changes in the shape and function of the esophagus with an annual timed
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238:. In Dor or anterior fundoplication, which is the most common method, part of the stomach (the
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After laparoscopic surgery, most patients can take clear liquids later the same day, start a
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fails to relax properly, making it difficult for food and liquids to reach the stomach.
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and laparoscopic instruments are inserted. The myotomy is a lengthwise cut along the
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272:, repeat myotomy (usually performed as an open procedure the second time around), or
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can be used to find studies on a surgeon's past experience with achalasia patients.
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480:"Laparoscopic Heller myotomy with minimal dissection and Dor anterior valve"
331:"Heller Myotomy Versus Heller Myotomy with Dor Fundoplication for Achalasia"
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or LES) are cut, allowing food and liquids to pass to the
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Surgical cutting of the lower esophageal sphincter muscles
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Cahais, J.; Lupinacci, R. M.; Valverde, A. (2018-07-24).
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206:During the procedure, the patient is put under
210:. Five or six small incisions are made in the
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1199:Transjugular intrahepatic portosystemic shunt
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51:introducing citations to additional sources
171:, a disorder in which the lower esophageal
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234:to reduce the incidence of postoperative
1005:Transanal hemorrhoidal dearterialization
41:Relevant discussion may be found on the
1162:Artificial extracorporeal liver support
539:UpToDate Patient Information: Achalasia
321:
380:"Minimally Invasive Abdominal Surgery"
113:
7:
717:Vertical banded gastroplasty surgery
766:Percutaneous endoscopic gastrostomy
574:Tests and procedures involving the
429:Journal of Gastrointestinal Surgery
130:
1204:Distal splenorenal shunt procedure
347:10.1097/01.sla.0000136940.32255.51
14:
250:is absent in achalasia patients.
222:Risks, complications, and outlook
34:relies largely or entirely on a
23:
995:Lateral internal sphincterotomy
497:10.1016/j.jviscsurg.2018.06.013
341:(3): 405–12, discussion 412–5.
702:Endoscopic sleeve gastroplasty
653:Functional Lumen Imaging Probe
1:
1084:Lower gastrointestinal series
828:Upper gastrointestinal series
1350:Diagnostic peritoneal lavage
1069:Double-contrast barium enema
896:Partial ileal bypass surgery
773:Esophagogastric dissociation
1167:Bioartificial liver devices
1094:Transrectal ultrasonography
484:Journal of Visceral Surgery
1691:
1089:Small-bowel follow-through
957:Abdominoperineal resection
816:Esophagogastroduodenoscopy
187:) or through the abdomen (
161:lower esophageal sphincter
1449:Clinical prediction rules
1355:Intraperitoneal injection
1059:Abdominal ultrasonography
967:Total mesorectal excision
886:Intestine transplantation
676:Sengstaken–Blakemore tube
658:High resolution manometry
648:Esophageal motility study
582:
441:10.1007/s11605-014-2547-8
310:List of surgeries by type
131:
1675:Digestive system surgery
1523:Tests and procedures on
1304:Pancreas transplantation
962:Lower anterior resection
643:Esophageal pH monitoring
585:Digestive system surgery
1398:Inguinal hernia surgery
1314:Pancreaticoduodenectomy
697:Adjustable gastric band
638:Impedance–pH monitoring
179:History and development
167:. It is used to treat
151:procedure in which the
1428:Exploratory laparotomy
1243:Hepatoportoenterostomy
707:Gastric bypass surgery
576:human digestive system
290:premalignant condition
1403:Femoral hernia repair
1189:Liver transplantation
783:Nissen fundoplication
1000:Rubber band ligation
939:Hartmann's operation
47:improve this article
1375:Peritoneal dialysis
1194:Portal hypertension
1099:Virtual colonoscopy
1074:Endoanal ultrasound
990:Anorectal manometry
985:Anal sphincterotomy
929:Colonic polypectomy
724:Collis gastroplasty
384:The Ochsner Journal
294:Barrett's esophagus
265:six weeks or more.
208:general anaesthesia
869:Jejunoileal bypass
712:Sleeve gastrectomy
270:pneumatic dilation
193:minimally invasive
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1435:Rapid urease test
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1319:Puestow procedure
1281:Cholescintigraphy
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1127:Stool guaiac test
1037:Capsule endoscopy
859:Bariatric surgery
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751:Gastroenterostomy
692:Bariatric surgery
435:(10): 1870–1875.
335:Annals of Surgery
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1647:Hemicorporectomy
1562:Electromyography
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278:barium swallow
274:oesophagectomy
255:Google Scholar
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145:Heller myotomy
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32:This article
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1654:Replantation
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1370:Paracentesis
1184:Liver biopsy
1079:Enteroclysis
1064:Defecography
919:Appendectomy
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1529:soft tissue
1360:Laparoscopy
1216:Gallbladder
1179:Hepatectomy
1109:Stool tests
1047:Proctoscopy
1042:Enteroscopy
1027:Colonoscopy
911:Large bowel
891:Jejunostomy
851:Small bowel
778:Hill repair
761:Gastrostomy
739:Billroth II
729:Gastrectomy
633:Sialography
280:. Regular
248:peristalsis
236:acid reflux
185:thoracotomy
1637:Amputation
1621:Bursectomy
1603:Fasciotomy
1423:Laparotomy
1365:Omentopexy
1342:Peritoneum
977:Anal canal
756:Gastropexy
734:Billroth I
316:References
189:laparotomy
103:April 2015
73:newspapers
1220:bile duct
1145:Accessory
1023:Endoscopy
934:Colostomy
924:Colectomy
881:Ileostomy
811:Endoscopy
744:Roux-en-Y
615:Esophagus
506:1878-7886
449:1873-4626
396:1524-5012
292:known as
286:dysphagia
282:endoscopy
262:soft diet
216:esophagus
202:Procedure
173:sphincter
169:achalasia
123:Specialty
43:talk page
1669:Category
1580:Tenotomy
1291:Pancreas
1032:Anoscopy
522:51727155
514:30054201
457:24878993
414:21765684
365:15319712
304:See also
149:surgical
1545:Myotomy
668:Stomach
465:1290385
405:3117521
356:1356431
288:, or a
165:stomach
155:of the
153:muscles
87:scholar
1595:Fascia
1572:Tendon
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1385:Hernia
949:Rectum
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157:cardia
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1630:Other
1613:Bursa
1467:UKELD
1416:Other
1154:Liver
518:S2CID
461:S2CID
147:is a
133:[
94:JSTOR
80:books
1527:and
1462:PELD
1457:MELD
1264:MRCP
1238:ERCP
510:PMID
502:ISSN
453:PMID
445:ISSN
410:PMID
392:ISSN
361:PMID
66:news
1269:PTC
611:SGs
492:doi
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