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Laparoscopic Cardiomyotomy for Achalasia

  • Posted on- Apr 18, 2018
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Laparoscopic Cardiomyotomy


The esophagus (food tube) passes food from the mouth to the stomach. A valve in the esophagus called the lower esophageal sphincter (LES) is located at the junction of the stomach and esophagus, allows the passage of food to the stomach and prevents the backflow of stomach acid into the esophagus.


Achalasia is a condition that causes weakening of the upper esophageal muscles and prevents complete relaxation of the lower esophageal sphincter (LES), making passage of food and liquids into the stomach difficult.


These problems create difficulty swallowing and can lead to weight loss, malnutrition, vomiting and dehydration.


Laparoscopic cardiomyotomy is a surgical procedure which is performed to open the tight sphincter muscle (LES) by cutting the thick outer muscle tissue between the esophagus and stomach.


This is generally followed by a partial fundoplication to prevent reflux following the surgery.  The surgery lets the food to pass easily into the stomach.


Pre-procedural Preparation


The patient will be on a liquid diet for 3-4 days before the procedure in order to clear the esophagus completely.


Procedure


Laparoscopic cardiomyotomy can be performed by a minimally invasive laparoscopic approach. The procedure will be performed under the effect of general anesthesia. The surgeon will make five to six small incisions for a laparoscopic approach on the patient’s upper abdomen.


For the laparoscopic approach, the surgeon will insert tiny instruments and a laparoscope (a thin tube with a lighted device and a camera at the end to view the internal organs on a screen) through the small incisions.


Steps involved in Laparoscopic Cardiomyotomy procedure:

  • The surgeon will make a lengthwise incision in the food tube, from just above the lower esophageal sphincter (LES) to slightly into the stomach tissues. Only the outer muscles of the esophagus will be cut, leaving the inner muscosal layer untouched. The incisions will reduce the force of the contracting muscles and relax the lower esophageal sphincter (LES) thereby, allowing food to pass easily
  • This makes it easy for the stomach acid to enter up into the esophagus. Hence, a fundoplication is often performed along with cardiomyotomy
  • To perform the fundoplication, the surgeon will wrap the upper part of the patient’s stomach around the lower esophageal sphincter (LES), like a collar, to strengthen it
  • Cardiomyotomy and fundoplication together will let the entry of food into the stomach and at the same time prevent the acid from refluxing back into the esophagus


Post-Operative care


Following the procedure, the patient may be discharged after a day if he has undergone a laparoscopic surgery. The patient may be advised to consume liquids and a soft food diet for a month. After fundoplication, the patient may be instructed to change his eating habits for a few months to help in the healing of the created esophageal valve.


Medications will be given for pain relief. Avoid strenuous activities, heavy lifting and driving for at least 2 weeks after surgery. Inform the doctor immediately if the patient experiences fever over 101°F, nausea or vomiting for 24 hours, constipation or diarrhea for over 48 hours, or swelling, redness and odorous drainage from the incisions.


Risks and Complications


Laparoscopic Cardiomyotomy involves some of the potential risks and complications. They include:

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