Heller's myotomy is an operation used to treat achalasia and vigorous achalasia. It involves complete division of the circular muscle at the level of the oesophagogastric junction.
Preparation should entail the clearing of any accumulated debris with suction through a rigid endoscope. Many approaches to the region have been used; lateral posterior thoracotomy at the level of the seventh rib is one of the most popular. The pleura over the oesophagus is moved laterally. The oesophagus, cardia and upper stomach are mobilized and drawn upwards. Exposed vessels are ligated and then divided. An incision is made down to mucosa longitudinally along the oesophagus for at least 7cm proximally or until no more hypertrophied muscle is encountered. Distally, the incision is extended a short distance onto the stomach.
Care needs to be taken to avoid perforation and cutting the vagal nerves. Postoperatively, antibiotic cover is required. An intercostal drain is removed after one day. The patient is nil by mouth for two days, on fluids for the next three days and then begins semi-solids.
Last reviewed 01/2018