Heller myotomy was developed as a surgical treatment for achalasia, a rare condition in which the sphincter in the lower esophagus, known as the cardia, cannot relax sufficiently to allow food and drink to travel to the stomach. It consists of either one big incision or several small incisions cut into the muscles of the cardia. The form of Heller myotomy that uses smaller incisions is a newer and more popular, as the laparoscopic instruments used to perform the procedure are less invasive and thus result in a lower risk and shorter recovery time for the patient.
Laparascopic Heller myotomy surgery typically starts with a surgeon cutting approximately three to six incisions in the cardia. Then surgical instruments similar to tubes are threaded through the incisions. Gas is then released into the abdominal cavity so that there is enough space for the surgeon to both see into and work in the abdomen. A camera is inserted in one of the surgical tubes so that the interior of the body can be viewed on a monitor.
The older, open method of Heller myotomy will usually only be performed if for some reason laparoscopic surgery is not possible. This procedure consists of one larger incision, which will give the surgeon adequate access to the esophagus. Once the esophagus has been accessed, the procedures continue in a similar manner.
After locating the connection between the stomach and the esophagus, the surgeon makes an incision on a muscular ring that surrounds the cardia. This cut only goes through the outside muscle layers of the esophagus, but it is deep enough to weaken the muscle that controls the sphincter. Muscles that were once squeezed tight are now less resistant to being moved.
Once the pressure on the esophagus has been released, food and drink can enter the stomach more freely. There is also an increased risk of acid reflux, however. In order to avoid this, some surgeons may perform a procedure called partial fundoplication in which a part of the stomach is moved over the esophagus so that acid cannot escape into the opening.
Heller myotomy is named after Ernest Heller, the surgeon who invented the procedure. He performed it for the first time in 1913. His open method, which was the most popular version until the introduction of laparoscopic surgery, was to access the interior of the body through the chest or abdomen.