From the Research
There is no established association between achalasia surgery and the development or worsening of portal hypertension. Achalasia surgery, which typically involves procedures like Heller myotomy (often with fundoplication) or peroral endoscopic myotomy (POEM), targets the lower esophageal sphincter to relieve the obstruction caused by this motility disorder. These procedures focus on the esophagogastric junction and do not directly affect the portal venous system or liver. Portal hypertension is primarily associated with liver disease, particularly cirrhosis, where increased resistance to portal blood flow leads to elevated pressure in the portal vein. The anatomical and physiological mechanisms involved in achalasia surgery do not impact hepatic blood flow or portal pressure.
However, if a patient has pre-existing liver disease or portal hypertension, they should inform their surgeon before undergoing achalasia surgery, as any major surgery carries general risks that could potentially stress the body in ways that might indirectly affect other conditions. Standard pre-operative assessment would typically identify any liver dysfunction or portal hypertension that might require special consideration during surgical planning, as noted in various studies on achalasia treatment outcomes 1, 2, 3, 4, 5.
Key points to consider include:
- The primary goal of achalasia surgery is to relieve symptoms by addressing the functional obstruction at the lower esophageal sphincter.
- Treatment options like POEM and Heller myotomy with fundoplication are effective and safe, with considerations for potential complications such as gastroesophageal reflux disease 3.
- Pre-existing conditions, including liver disease and portal hypertension, should be evaluated pre-operatively to ensure appropriate surgical planning and management.
- The current evidence base, including systematic reviews and meta-analyses, does not support a direct link between achalasia surgery and the development or worsening of portal hypertension 1, 3.