NYU Langone surgeons use a minimally invasive procedure, called a laparoscopic Heller myotomy, to widen the lower esophageal sphincter—the muscular valve in the esophagus that allows food to pass into the stomach. Most people who can tolerate general anesthesia are good candidates for this procedure, including those who have already had upper abdominal surgery.
During this procedure, the surgeon makes four or five small incisions in the upper portion of the abdomen. He or she inserts tiny instruments and a long, flexible tube with a camera at the end, called a laparoscope, into the abdomen.
With guidance from the laparoscope, the surgeon separates the stomach and esophagus from the surrounding tissues. The surgeon cuts into the top layer of the lower part of the esophagus and upper part of the stomach to loosen them.
Although complications of this procedure are rare, some people may develop a perforation in the lower esophageal sphincter. If this occurs, it usually heals on its own while you are in the hospital.
After a Heller myotomy, most people are able to return home within one to two days. You may have a swallowing study called a barium esophagram while you’re in the hospital to ensure the esophagus isn’t leaking.
Your doctor may recommend sticking to a liquid diet for a week, then slowly incorporating soft foods into your diet. Most people experience relief almost immediately after surgery, and studies show that the majority continue to have symptom relief a decade later.
Many people develop gastroesophageal reflux disease, or GERD, after a Heller myotomy. Because the procedure loosens the lower esophageal sphincter, it may allow stomach acid to travel backward into the esophagus. For this reason, the surgeon may recommend an additional procedure, called a fundoplication, during the Heller myotomy to prevent GERD symptoms.
During a fundoplication, the surgeon wraps the upper part of the stomach, called the fundus, around the bottom of the esophagus to strengthen the valve and prevent stomach acid from flowing back into the esophagus.