Laparoscopic Cardiomyotomy (Heller Myotomy)

Overview

Laparoscopic cardiomyotomy — better known as a Heller myotomy — is keyhole surgery to treat achalasia, a disorder in which the muscular valve between the esophagus and stomach (the lower esophageal sphincter) does not relax properly. As a result, food and liquid back up in the esophagus and swallowing becomes difficult.

During the operation, the surgeon carefully cuts the tight muscle fibers of this valve so that it stays open enough for food to pass into the stomach. Because loosening the valve can allow acid reflux, a partial fundoplication (wrapping part of the stomach around the lower esophagus) is usually added in the same procedure.

The goal is to relieve the swallowing difficulty and regurgitation caused by achalasia. This page is an educational overview only — it is not medical advice, and no outcome can be guaranteed.

Who May Need This

Heller myotomy may be considered for people diagnosed with achalasia who have troublesome symptoms such as difficulty swallowing solids and liquids, regurgitation of undigested food, chest discomfort, and weight loss. It is one of the main long-term treatments for the condition.

Candidates are usually reasonably fit for laparoscopic surgery under general anesthesia. Suitability depends on the type and severity of achalasia, previous treatments, and overall health. Eligibility can only be determined by a gastrointestinal surgeon and gastroenterologist after full testing.

When It May Be Recommended

Surgery may be recommended when tests confirm achalasia and symptoms significantly affect eating and quality of life, particularly when less invasive treatments such as balloon dilation have not provided lasting relief or are not preferred. It is often chosen for younger, fit patients seeking a durable result.

The decision compares Heller myotomy with alternatives such as pneumatic dilation and POEM, taking into account the achalasia subtype and patient preference. The final recommendation always depends on individual evaluation.

Diagnosis and Evaluation

Diagnosis usually involves esophageal manometry (measuring the pressure and coordination of esophageal muscles), a barium swallow X-ray that can show the classic narrowed lower esophagus, and upper endoscopy to inspect the esophagus and rule out other causes such as a tumor.

Your fitness for surgery is assessed, nutrition is reviewed since some patients have lost weight, and all medications are checked. A second opinion may be valuable, and choosing between myotomy, dilation, and POEM is best done with a specialist team.

Treatment Options

Options for achalasia include pneumatic balloon dilation (endoscopically stretching the valve), POEM (per-oral endoscopic myotomy performed through the mouth), laparoscopic Heller myotomy with partial fundoplication, and, for those unfit for procedures, botulinum toxin injection as a temporary measure or medications.

Each option differs in durability, reflux risk, and invasiveness. Botulinum toxin tends to be short-lived; dilation may need repeating; myotomy and POEM are more durable. Your specialist will explain which best fits your achalasia type and goals.

How It Is Performed

Under general anesthesia, the abdomen is inflated with carbon dioxide gas and the surgeon works through several small incisions with a camera and instruments. The lower esophagus and top of the stomach are exposed, and the surgeon divides the muscle layers of the lower esophageal sphincter lengthwise while leaving the inner lining intact.

A partial fundoplication is then usually created by wrapping part of the stomach around the lower esophagus to reduce reflux. The lining may be checked for any tiny hole during surgery. The procedure commonly takes one to three hours. Rarely, conversion to open surgery is needed.

Preparation

Preparation typically includes completing pre-operative tests and manometry, following a liquid diet for a day or two before surgery so the esophagus is empty (important because food can pool above the valve), adjusting medications, stopping smoking, and following fasting instructions.

If travelling abroad, arrange for a companion, plan the recommended in-country stay, and bring your manometry, barium swallow, and endoscopy reports so the surgical team has your full history.

Benefits and Expected Goals

The goal is to relieve difficulty swallowing and regurgitation by loosening the tight valve, allowing food to pass into the stomach and improving nutrition and quality of life. Adding a partial wrap aims to keep reflux under control.

Benefits vary by individual and achalasia subtype. Achalasia is a chronic disorder, so the surgery relieves the obstruction rather than restoring normal esophageal function, and some symptoms can persist or return. Your specialist can discuss realistic goals for your situation.

Risks and Possible Complications

As with any esophageal surgery, there are real risks. A particular concern is a perforation (small hole) in the esophageal or stomach lining during muscle cutting, which is usually repaired at the same time but can lead to a leak if unrecognized.

• Acid reflux or heartburn after the valve is loosened (reduced by the fundoplication)
• Persistent or recurrent difficulty swallowing if the myotomy is incomplete or scarring occurs
• Bleeding, infection, or injury to nearby structures
• Problems with the fundoplication wrap, such as it being too tight or slipping
• Blood clots, conversion to open surgery, and anesthesia-related risks

Your surgical team will explain the risks specific to your case. Report severe chest or abdominal pain, fever, or inability to swallow promptly.

Recovery, Follow-up & Aftercare

Many patients stay in hospital for one to two days. Some centers perform a swallow study before you eat to confirm there is no leak. You start with liquids and progress to soft foods and then a normal diet over a few weeks, eating slowly and chewing well.

Avoid heavy lifting for a few weeks. Long-term follow-up monitors swallowing and reflux, and some patients take acid-reducing medication. Recovery varies by individual. Arrange follow-up with your gastroenterologist or surgeon before travelling home.

Medical Tourism Planning

If you are considering Heller myotomy abroad, choose a JCI- or ISO-accredited hospital with an established GI or foregut surgery program, esophageal testing (manometry), and endoscopy on site. Verify the surgeon's experience with laparoscopic myotomy and fundoplication specifically.

Plan an adequate in-country stay for surgery and early recovery, confirm how follow-up and any reflux monitoring will be handled, and arrange continuing care at home. Consider medical travel insurance and request a written treatment plan and cost estimate before you travel.

Estimated Cost Factors

The cost depends on the country and hospital, the surgeon's fees, whether robot assistance is used, length of stay, pre-operative testing such as manometry, and any treatment of complications. An added fundoplication is usually part of the same operation.

Many international destinations offer this surgery at a fraction of typical US prices, but figures vary widely by case. Online prices are only estimates — always request a personalized written quote that lists what is included before making any decision.

Choosing a Hospital or Specialist

Look for a hospital with recognized accreditation and a dedicated foregut or GI surgery unit, on-site manometry and endoscopy, and intensive care. Confirm the surgeon's board certification and specific experience with achalasia surgery, since technique and outcomes improve with volume.

Ask about complication rates, how a perforation would be managed, international patient services, and interpreter support. Transparent, written cost and treatment plans and honest discussion of risks are signs of a quality program.

Alternatives

Depending on your achalasia type and health, alternatives may include pneumatic balloon dilation, POEM, botulinum toxin injection (temporary, often for those unfit for surgery), or medications to relax the valve (limited effect).

Each option has different durability, reflux risk, and invasiveness. Discuss all of them with your specialist so the plan fits your achalasia subtype, fitness, and preferences.

Questions to Ask Your Doctor

• Which achalasia treatment is best for my subtype — myotomy, POEM, or dilation?
• Will you add a fundoplication, and which type?
• How many Heller myotomies do you perform each year, and what are your outcomes?
• What are the risks in my case, and how would a perforation be handled?
• How likely am I to still need reflux medication afterward?
• How long should I stay in-country, and when can I safely fly home?
• What is included in the written cost estimate?