What is achalasia?

Achalasia is a condition that causes problems with swallowing. It can also cause regurgitation (bringing food back into your mouth), chest pain and weight loss.

The lower oesophageal sphincter is the valve that controls how food passes into your stomach.

Achalasia is where the valve does not relax properly.

What are the benefits of surgery?

The aim is to make it easier for you to swallow. The benefits will often last for a lifetime.

Are there any alternatives to surgery?

The alternatives to surgery will usually give only temporary relief from your symptoms.

• changing the way you eat
• changing what you eat
• medication
• botox injections
• balloon dilatation

Surgery is the only dependable way to give lasting relief from your symptoms.

A new procedure called peroral endoscopic myotomy (POEM) is available in a few centres.

What will happen if I decide not to have the operation?

Your surgeon will recommend the most appropriate non-surgical treatment for you but your symptoms are likely to get worse over time.

What does the operation involve?

Achalasia is treated surgically by cutting the muscle of the lower oesophageal sphincter. This should open the passage between your oesophagus and stomach, making it easier for you to swallow.

The operation is performed under a general anaesthetic and usually takes an hour to 90 minutes.

Your surgeon will use laparoscopic (keyhole) surgery, as this is associated with less pain, less scarring and a faster return to normal activities.

They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen.

Your surgeon will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the operation.

Your surgeon will cut and spread apart the layers of muscle of the lower oesophageal sphincter and lower end of your oesophagus.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• bleeding during or after the operation
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• developing a hernia in the scar
• blood clot in your leg (deep-vein thrombosis – DVT)
• blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs
• chest infection. Your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation

Specific complications of this operation

Keyhole surgery complications

• surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide)
• damage to structures such as your bowel, liver or blood vessels when inserting instruments into your abdomen. The risk is higher if you have had previous surgery to your abdomen. About 1 in 3 of these injuries is not obvious until after the operation
• developing a hernia near one of the cuts used to insert the ports
• gas embolism. This is when gas (carbon dioxide) gets into the bloodstream and blocks a blood vessel

Cardiomyotomy complications

• making a hole in your oesophagus or stomach (perforation). Your surgeon will usually notice any damage and repair it during the operation. If your surgeon does not notice the damage, it can lead to serious complications. For this reason you may have an endoscopy
• difficulty swallowing
• developing acid reflux, which causes a burning sensation in your chest (‘heartburn’) or acid in the back of your mouth
• pneumothorax, where air escapes into the space around your lung

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home after 1 to 3 days.

You should be able to return to work after 2 weeks, depending on how much surgery you need and your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery.

Summary

Achalasia is not life-threatening but the symptoms can be disabling. A Heller’s cardiomyotomy is a dependable way to help you to swallow more easily for a long time.

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