A Heller myotomy is the cutting of muscles of the lower esophageal sphincter (LES). The LES is a ring of muscle at the bottom of the esophagus. It allows food and liquids to pass into the stomach. It is used to treat achalasia, a disorder that prevents the LES from relaxing and allowing food and liquid to pass. Named after Ernest Heller, who first performed it in 1913, this procedure used to be an open surgery, either through the chest (thoracotomy) or through the abdomen (laparotomy. Today, the procedure is usually performed using minimally invasive surgical techniques.

The surgery

You will be placed under general anesthesia and will feel no pain. Your doctor will make several small incisions in your abdominal wall and will insert laparoscopic tools.

Your physician will then make a lengthwise cut along the esophagus, starting above the LES and ending a short distance into the stomach. The myotomy only cuts the outside muscle layers of the esophagus. It does not cut the inner lining.

A Heller myotomy will allow food to easily pass into the stomach. Your physician will make sure that you are protected from acid reflux, which can occur after this surgery. Your physician may do any of the following:

• Dor (anterior) fundoplication: This frontal approach is the most common anti-reflux surgery. Part of the stomach (called the fundus) is laid over the front of the esophagus and stitched in place. When the stomach contracts, a seal is made at the esophagus.
• Toupet (posterior) fundoplication: This rear approach stitches the fundus across the back of the esophagus.
• Nissen (complete) fundoplication: This approach wraps the fundus completely around the esophagus. It is not advised for patients with achalasia because it may cause problems with peristalsis (the movements that help send food down the esophagus).

Most patients may take clear liquids the same day after a Heller myotomy. You may begin a soft food diet 2 to 3 days later. Within a month, you may return to a normal diet.

If you receive the minimally invasive surgical approach, your hospital stay will be approximately two to three days. You may be able to return to work in two to three weeks.

If you receive the open surgery, you may have to be away from work for at least a month. You may not do any heavy lifting for at least six weeks.

If you have achalasia, a Heller myotomy will offer long-term relief, but it will not completely eliminate symptoms. It is not a cure for achalasia. You may have to get another myotomy or an esophagectomy if acid reflux damages your esophagus. For most patients who have achalasia, however, myotomy is a surgery with proven effectiveness.