Heller Myotomy is NOT Bariatric Surgery
Heller myotomy is an esophageal surgical procedure performed to treat achalasia and esophagogastric junction outflow obstruction—it is definitively not a bariatric surgery. Bariatric surgery refers to weight loss procedures that modify the gastrointestinal tract to treat obesity, whereas Heller myotomy addresses esophageal motility disorders by dividing the lower esophageal sphincter muscles.
Purpose and Indication
Heller myotomy treats achalasia, a primary esophageal motility disorder characterized by absent peristalsis and defective lower esophageal sphincter relaxation, causing dysphagia, regurgitation, weight loss, and chest pain 1.
The procedure divides the circular and longitudinal muscle layers of the lower esophageal sphincter to relieve esophagogastric junction outflow obstruction 2.
Laparoscopic Heller myotomy (LHM), per-oral endoscopic myotomy (POEM), and pneumatic dilation are the effective treatment modalities for achalasia—none of which are bariatric procedures 1.
Surgical Technique
The myotomy extends approximately 7 cm, with 1.5-2 cm onto the gastric wall, and requires concomitant fundoplication (typically Dor or Toupet) to prevent postoperative gastroesophageal reflux 2, 3.
The surgical dissection disrupts important anti-reflux mechanisms, making fundoplication necessary to prevent reflux complications 2.
Success rates exceed 90% for symptom relief in achalasia patients 4, 3.
Important Clinical Distinction
While Heller myotomy can be performed in patients who have previously undergone bariatric surgery, this does not make it a bariatric procedure 1.
One case report describes achalasia developing after gastric bypass, requiring subsequent Heller myotomy—this illustrates that these are separate, distinct surgical interventions addressing different pathologies 5.
The evidence mentions that manometric findings similar to achalasia can occur after bariatric surgery, but this refers to complications of bariatric procedures, not the classification of Heller myotomy itself 1.
Common Pitfall to Avoid
Do not confuse the anatomical location (both involve the upper gastrointestinal tract) with the surgical purpose. Heller myotomy is a functional esophageal surgery targeting sphincter dysfunction, while bariatric surgery is a metabolic/weight loss surgery targeting obesity through gastric restriction or malabsorption.