Heller Esophageal Myotomy (esophagomyotomy) for Achalasia

Achalasia is a disorder of the esophagus that prevents normal swallowing. Under normal conditions, a ring of muscle called the lower esophageal sphincter located just above the stomach remains contracted to prevent reflux. When food arrives, however, it relaxes in order to allow food to enter the stomach. In achalasia, the esophageal sphincter remains contracted. An esophagomyotomy, also called a Heller Myotomy, is a surgical therapy for achalasia. This procedure can be performed laparoscopically, in which four to five small incisions about ½ cm long are made. With laparoscopic instruments, the muscle of the lower esophageal sphincter is cut (myotomy) allowing food to pass easily into the stomach.

Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. However, the incidence of esophageal perforation reported is about 5%–10%. Robotic-assisted Heller myotomy (RAHM) has emerged as a safer alternative to LHM. In November 2005, a study in the Journal of Gastrointestinal Surgery suggested that RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups.

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