Heller’s myotomy for Achalasia
Discuss Heller’s myotomy?
Laparoscopic Heller myotomy is considered to be the primary treatment for achalasia by many because of excellent results, a short hospital stay (1-2 days) and a faster recovery time (regular activities in 2 weeks). Heller’s myotomy often leads to postoperative GORD and hence most surgeons add partial fundoplication to laparoscopic Heller’s myotomy
Surgical technique
- The myotomy is carried out from 6 cms above the OG junction to 2-2.5 cms onto the gastric wall. A proper submucosal plane is reached at a point and then the myotomy (both circular and longitudinal fibres are cut) is extended up and down.
- Surgical myotomy results in sustained remission rates of approximately 70 to 85 percent at 10 years, and 65 percent at 20 years.
- The overall complication rate of laparoscopic myotomy is around 6 percent, while mortality rate of approximately 0.1 percent is similar to that reported for pneumatic dilation
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