Complications are possible in all operations and esophageal myotomy is no different. Complications common to both open and laparoscopic myotomy are:
- Bleeding. Fortunately, bleeding during or after this procedure is very uncommon. As a result, we do not routinely ask patients to donate their own blood prior to surgery. However, self (autologous) donation of blood can be arranged prior to the operation.
- Infection. Infection from esophageal myotomy can occur in the incision, in another organ such as the lungs or at the site of the myotomy. Infection at the incision and at another site are more common following open surgery than laparoscopic, but still is quite unusual.
- Perforation. Infection at the site of the myotomy is usually related to a perforation of the inner lining of the esophagus. This may require an additional operation, but often can be treated with antibiotics.
Late complications of myotomy include the development of a hernia at the site of an incision, a bowel obstruction or recurrence of the achalasia. The formation of a hernia and the later development of a bowel obstruction are both more common following an open myotomy than a laparoscopic one. Hernia is more common because the incision is larger. Bowel obstruction is more common because open surgery produces more scar tissue (adhesions) than laparoscopic surgery. Approximately 90 percent of patients have good to excellent results following surgery; it is maintained long term in 90 percent of these patients.
Laparoscopic surgery has rare complications related to the initiation of the laparoscopy itself. Approximately one in 1000 patients will have an injury to the intestine or a major blood vessel when we start the laparoscopy. If this should occur, the surgeon may need to convert the operation to an open one to correct the problem.
This incidence can be reduced to almost zero by using a technique call open laparoscopy. In this technique a small incision is made into the abdomen under direct vision rather than placing a needle into the abdomen to start the laparoscopy. We always use the open technique and have not had a significant problem with it to date.