Heller myotomy involves cutting the muscle fibers of the lower esophagus. The procedure has been performed since 1914 with good to excellent results. The procedure can be performed either through a conventional incision in the abdomen or through a laparoscopic approach.
In an open or conventional esophageal myotomy, an incision is made from the breastbone to the belly button. The esophagus is isolated as it passes from the chest through the diaphragm and into the abdomen. The muscle fibers on the esophagus are cut to the inner lining of the esophagus, the mucosa.
Usually, the operation takes from one to two hours. The longer operation results when the myotomy is combined with an anti-reflux operation.
Approximately 90 percent of patients undergoing an esophageal myotomy have good to excellent results. This is maintained long-term in 90 percent of these patients. Therefore, 85 percent of all patients undergoing an esophageal myotomy should have a good to excellent long-term result that requires no further therapy
Bleeding and infection are possible after esophageal myotomy, as is the case for any operation. Fortunately, these occur rarely. Perforation of the inner lining of the esophagus is also possible during the operation. This is repaired at that time and usually does not lead to long-term problems. Overall, the chance of complication is 5 to 10 percent, and death is very unusual.
When is surgery not recommended?
Patients who are at high risk for surgical complications should try other therapies before considering surgery. In these patients, surgery should be a last resort.