Surgical Treatment for Achalasia
Surgery: The Best Treatment Method
Most authorities believe the best long-term results are obtained with surgery. This opinion is based on numerous studies comparing open esophageal myotomy to pneumatic dilatation. The recent introduction of the laparoscopic approach has placed even greater favor on the surgical procedure. Some doctors today believe a laparoscopic myotomy is the procedure of choice.
However, surgery is the most invasive of the three treatments. It seems only reasonable to try the botulinum toxin injections at least once. In some people the injections offer long-term relief and, in most, at least short-term relief. This period of time can be used to regain nutritional strength. Should injection fail patients will be in better overall condition for one of the other procedures.
Some authorities believe age is an important determinant of the therapy used, since pneumatic dilatation is not as successful in patients under 40 years of age compared to patients over 40. In fact, pneumatic dilatation is reported to be less than 70 percent effective in people under 40 years of age. Thus, surgery may be the best option for this group.
It is important to consider that pneumatic dilatation is less invasive than surgery. Thus, at least one attempt at dilatation should be considered in most patients before surgery, unless patients have had previous surgery near the lower esophageal sphincter, have a large hiatal hernia, have a very tortuous esophagus, have significant inflammation of the distal esophagus or an outpouching of the distal esophagus known as an epiphrenic diverticulum. These patients are not good candidates for pneumatic distillation, as studies have shown a higher risk of perforation.
Surgical Options
Surgical treatment for Achalasia focuses on relieving the tight lower esophageal sphincter so food can pass into the stomach more easily.
Laparoscopic or Robotic Heller Myotomy with Fundoplication
The most common surgical treatment of achalasia is Heller Myotomy. In this procedure, the surgeon cuts the tight esophageal muscle to improve swallowing. It is often performed laparoscopically (minimally invasive.)
It is frequently combined with a partial anti-reflux procedure to prevent Gastroesophageal Reflux Disease (GERD.)
Frequently Asked Questions About Heller Myotomy
Laparoscopic (Robotic Heller Myotomy with Fundoplication) is a small-incision surgery where the lower esophagus (LES muscle) is divided and a partial fundoplication is performed to reduce reflux. Fundoplication is a surgery that helps prevent acid reflux by wrapping the top part of the stomach around the lower esophagus to strengthen the valve between them.
Laparoscopic or robotic Heller myotomy with fundoplication offers long-lasting relief from swallowing problems and helps prevent acid reflux. It’s a minimally invasive procedure with a strong track record, though recovery may take a bit longer than other options and it does require general anesthesia.
With a laparoscopic or robotic Heller myotomy with fundoplication, you can expect:
- Hospital Stay: Most POEM patients go home the same day or after a single overnight stay.
- Recovery: Most patients who undergo POEM return to light activity within days. Their diet advances gradually over one to two weeks.
- Results: Most patients experience dramatic improvement in swallowing and quality of life.
- Long-term follow-up: Your Brown Health care team will monitor for reflux and provide ongoing care as needed.
Peroral Endoscopic Myotomy (POEM)
Peroral Endoscopic Myotomy is a newer, minimally invasive endoscopic technique with no external incisions. It also cuts the muscle from inside the esophagus. This treatment is effective for many patients, including more complex cases of achalasia. It has a higher risk of post-procedure reflux compared to Heller myotomy.
Frequently Asked Questions About POEM
POEM is a minimally invasive endoscopic procedure performed entirely through the mouth. The tight muscle of the lower esophagus (LES) is cut from the inside, relieving obstruction.
POEM requires so external incisions. Patients usually have shorter hospital stays and can return to their normal diet and work sooner. There are excellent short- and mid-term swallowing outcomes.
Patients may have a higher risk of reflux however, your care team will monitor and managed this with you.
We offer expert, personalized laparoscopic or robotic heller myotomy with fundoplication care backed by advanced techniques and a commitment to long-term outcomes.
- Local expertise: Brown Health was the first in Rhode Island to establish a POEM program in Rhode Island.
- Comprehensive care: We offer both POEM and laparoscopic/robotic Heller, tailoring treatment to patient goals and anatomy.
- Advanced technology: Endoscopic and robotic platforms for precision and safety.
- Collaborative team: Fellowship-trained MIS surgeons, gastroenterologists, anesthesiologists, and dietitians working together.