Specializing in Minimally Invasive Surgery
 
We specialize in minimally
invasive surgery including:


Appendix
Adrenal
Colon
Gallbladder
Hernia
Reflux Surgery
Esophageal Myotomy for Achalasia

General Surgical service for
treatment of the following:


Anorectal Disease
Breast Disease
Dialysis Access
Endocrine Disease
Gastrointestinal Disease
Hernias
Lower Extremity Venous Disease
Skin Cancer
Spleen
Trauma Surgery
Pediatric Surgery

McLeod Health

























A Chance "To Get Her Life Back"
McLeod Magazine, Vol 22, Issue 2, 2007
[Click Here] 128k PDF




Achalasia

What is achalasia?
Achalasia is a motility disorder of the esophagus. The esophagus is the tube that food travels through to get from the mouth to the stomach. With achalasia, this movement is impaired. This impairment occurs because the valve between the esophagus and stomach, known as the Lower Esophageal Sphincter (LES), does not relax and remains very tightly contracted. Another abnormality seen in achalasia is that the esophagus doesn't contract to "push" the food down into the stomach. Because of these abnormalities, it is difficult for food to get down to the end of the esophagus and once it gets there, the closed valve prohibits the food from moving into the stomach. The cause of achalasia is unknown.

What are the symptoms of achalasia?
Achalasia begins as a difficulty in swallowing, known as dysphagia. Initially, patients may only have trouble swallowing solid foods. This can progress to the point that liquids cannot be swallowed either. Regurgitation, or spitting up undigested food, also occurs. Some patients also experience a pain in their chest. These symptoms are frequently present for years before the diagnosis of achalasia is made.

How common is achalasia?
Achalasia occurs in one per 100,000 people per year. The usual age at diagnosis is between 20 and 60 years. It occurs equally as often in men and women.

How is achalasia diagnosed?
Achalasia is diagnosed by an experienced gastroenterologist. Several tests are performed to make the diagnosis, including an EGD, a barium swallow, and manometry.

What are the treatment options?
The treatment of achalasia is aimed at decreasing the pressure in the LES. Unfortunately there is not a medication that is able to accomplish this. Currently there are three main treatment options. Pneumatic Balloon Dilation: this is done through an endoscope. The advantage of this is that it can be done on an outpatient basis. A major disadvantage is that it is not a permanent solution for most patients and must be frequently repeated. Another risk is that the esophagus can be torn during this procedure. Botox Injection: this will relax the LES for only a short time, frequently only several months. Surgical myotomy: this is the only permanent solution and is the preferred treatment for patients who are surgical candidates.

How is a Heller myotomy performed?
Surgical treatment for achalasia is usually done laparoscopically. This is done through five small incisions in the abdomen. The LES muscle is divided, leaving it in a relaxed, or open position. This will allow food to pass from the esophagus down into the stomach. To prevent or lessen reflux postoperatively, a partial wrap is frequently added to the procedure.

What is the usual postoperative course?
Patients are usually in the hospital for 2 - 3 days after surgery. Liquids are started the day after surgery and this is gradually progressed to a soft diet. Hard foods, such as meats, are avoided for several months. Patients are also given medication for reflux. Because the procedure is done laparoscopically, patients usually return to full activity within 1 - 2 weeks.