Print Handheld Contrast

Myotomy

What is it?

A myotomy is a surgical procedure to treat achalasia, a condition in which a patient has problems swallowing food.

Why?

When food arrives at the end of the esophagus, the muscular valve known as the lower esophageal sphincter fails to relax to allow food into the stomach. To treat achalasia, the muscle around the gastroesophageal junction must be cut to limit its ability to block the passage of food.  A myotomy procedure can be performed through a large incision or through several small incisions using laparoscopic instruments. Since development of the laparoscopic procedure, recovery time has been reduced significantly.

Preoperative  Evaluation

You will need to undergo several tests before surgery in order to make the procedure as safe as possible.  You may require some or all of the following:

• Blood tests

• Electrocariogram (ECG)

• Manometry

• See other specialists

You will also be assessed before surgery in the Pre-Admission Clinic, Zone C Level 2, to ensure all necessary procedures have been completed.

Procedure

If your surgery 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.

Time

The procedure takes between 1 to 2 hours and is done in the Operating Room at Victoria Hospital. You will need to register in the Admitting/Patient Registration at London Health Sciences Centre's (LHSC) Victoria Hospital located in Zone B Level 2 (B2-100) at least 2 hours before your scheduled operation.

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. You will be directed to the Day Surgery Unit located in Zone D Level 2, where you will be assessed by a nurse and have an intravenous started. 

Family and Friends

Family and friends may wait in the Perioperative Waiting Room located in Zone D Level 2 (D2-100). 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

2. You have a temperature of 38.5° C (101.50° F).
   
   
3. You have any questions.