What is one of the purposes of having a Heller myotomy?

From the Guidelines

A Heller myotomy is primarily performed to relieve the obstruction at the gastroesophageal junction, allowing for easier passage of food from the esophagus into the stomach, thereby alleviating symptoms of achalasia, such as dysphagia, regurgitation, chest pain, and weight loss. This surgical procedure is used to treat achalasia, a disorder where the lower esophageal sphincter fails to relax properly during swallowing, by cutting the circular muscle fibers of the lower esophageal sphincter [ 1 ]. The goal of the procedure is to provide significant symptom relief for most patients, improving their quality of life, despite not curing the underlying neurological disorder causing achalasia [ 1 ].

Key Points

• The procedure can be performed laparoscopically or through a thoracoscopic approach, with most surgeons extending the myotomy onto the stomach to ensure complete division of the sphincter.
• Patients with achalasia may undergo a comprehensive diagnostic workup, including clinical history, upper endoscopy, timed barium esophagram, and high-resolution manometry, before deciding on a treatment modality [ 1 ].
• The decision between POEM, laparoscopic Heller myotomy, and pneumatic dilation should be based on shared decision making, taking into account patient and disease characteristics, patient preferences, and local expertise [ 1 ].
• After surgery, patients may develop gastroesophageal reflux as a side effect, which can be managed with medication or by adding a partial fundoplication during the procedure [ 1 ].

Considerations

• Patients should undergo monitoring for gastroesophageal reflux disease after POEM, and those with persistent esophagitis and/or reflux-like symptoms despite proton pump inhibitor use should undergo additional testing to evaluate for other etiologies [ 1 ].
• Long-term postprocedure surveillance is encouraged to monitor for progression of disease and complications of gastroesophageal reflux disease [ 1 ].

From the Research

Purpose of Heller Myotomy

• One of the purposes of having a Heller myotomy is to treat achalasia, a condition characterized by difficulty swallowing due to abnormal muscle contractions in the esophagus 2, 3, 4, 5, 6.
• The procedure involves cutting the muscle at the end of the esophagus, including the lower esophageal sphincter, to allow food to pass more easily into the stomach 2, 3, 4.
• Heller myotomy has been shown to be an effective primary treatment for achalasia, with studies demonstrating significant improvement in symptoms such as dysphagia, regurgitation, and chest pain 2, 4.
• The procedure can be performed laparoscopically, which has become the preferred treatment modality for achalasia due to its high success rate, short hospital stay, and fast recovery time 5, 6.

Key Findings

• Studies have compared the outcomes of patients undergoing Heller myotomy with and without prior endoscopic therapy, such as pneumatic dilation and botulinum toxin injection 2, 4.
• The results suggest that patients who undergo Heller myotomy without prior endoscopic therapy tend to have better outcomes, with fewer complications and improved symptom relief 2, 4.
• The addition of a fundoplication to the Heller myotomy procedure is also a topic of discussion, with some studies suggesting that it may help prevent or control gastroesophageal reflux after the myotomy 5, 6.