Achalasia

What is it?

Achalasia is a disease of the muscle of the esophagus. The term achalasia means 'failure to relax' and refers to the inability of the lower esophageal sphincter (a ring of muscle between the lower esophagus and the stomach) to open and let food pass into the stomach. As a resut, patients often have difficulty swallowing.

Esophageal Sphincter

Preoperative  Evaluation

You may need to undergo several tests before surgery in order to make the procedure as safe as possible including:

 

Treatments

   
  • Medication
 
  • Endoscopic Botulinum Toxin Injection
  Botox Injection
   
  • Endoscopic Dilation
Dilation
   
  • Peroral Endoscopic Myotomy (POEM)
  POEM
   
  • Surgery - Heller Myotomy
Myotomy

If your myotomy is performed laparoscopically, your surgeon will make three to four small incisions, and insert tube-like instruments through them.

The abdomen will be filled with gas to help the surgeon view the abdominal cavity. A camera will be inserted through one of the tubes that will display images on a monitor in the operating room. In this manner, your surgeon will be able to work inside your abdomen without making a larger incision.

Your surgeon will perform the Myotomy procedure with the laparoscopic method unless other factors require open surgery. If performed with the open method, one larger incision will be made.

Once inside, the junction between the esophagus and stomach is found. A lengthwise incision is then made on the muscular ring surrounding the lower esophageal sphincter. Your surgeon may perform an additional procedure to prevent reflux.

Risks


As with all surgery there are risks. The surgical risks include bleeding, infection, irregular heart beats, stroke, a reaction to anesthesia and sometimes death.

Before Your Procedure


DO NOT EAT OR DRINK ANYTHING, including water, after midnight the night before surgery unless instructed otherwise by your surgeon. Leave jewellery and valuables at home.  Ensure that you tell the staff if you are taking any 'blood thinners' or other medications.  

Family and Friends


Family and friends may wait in the Perioperative Waiting Room. Your surgeon will come to speak with them following the procedure, so it is advisable for them to wait there.

After Surgery


You will wake up in the Post Anesthesia Care Unit (PACU or 'recovery room').  You will have an intravenous tube.  You will be transferred to the Thoracic Observation Unit, Zone C Level 5, for the remainder of your stay. You may eat and drink immediately after surgery. 

Pain


There is mild pain with this surgery. You will be given medication in order to control any pain you have.

Discharge


Your length of stay will depend on your digestive behaviour and your ability to tolerate physical activity. If the surgery has been done using smaller incisions, the length of stay is typically shorter. The average patient goes home after 1 to 2 days.

You must go home with either a friend or relative by private vehicle or by taxi, NOT by public transportation. 

Dressings

Bandaids will cover the small incisions.  These should be kept dry and left in place for 2 days.  After 2 days, remove them and gently wash the incisions with mild soap in the shower.

Activity

You are encouraged to do your regular activities except:

  • No heavy lifting for 2 to 3 weeks.
  • Do not drive a car if taking narcotics.

Prescriptions

You will be given a prescription to reduce stomach acid and for pain control.

Follow-Up

Before you leave the hospital, your nurse will schedule a return appointment with your surgeon. This will be in approximately 4 to 6 weeks time. 

Call your surgeon's office if:

  1. You have any excess:
    • Drainage from the wound
    • Pain
    • Shortness of breath
    • Dificulty swallowing
  1. You have a temperature of 38.5° C (101.50° F).

  2. You have any questions.

LHSCPatients, Families & Visitors

Last Updated March 26, 2015 | © 2007, LHSC, London Ontario Canada