Achalasia, a disorder characterized by trouble swallowing, can sometimes require surgical intervention. The goal of achalasia treatment is to improve the patient’s quality of life as much as possible, knowing there is no cure for this disease. No interventions restore the motility of the esophagus, but interventions to help the lower esophageal sphincter can be beneficial to patients.
Swallowing can often be improved with interventions to help the lower esophageal sphincter stay open; chest pain and discomfort generally do not respond as well to therapy.
Achalasia surgery has demonstrated the most success long term in the treatment of achalasia. The surgery, called a Heller myotomy, involves laparoscopically (small incisions in the abdomen) cutting the muscle of the valve and then rebuilding the valve to prevent reflux. Most patients notice improvement in swallowing immediately. There are small risks of recurrent swallowing problems and reflux/heartburn.
A new surgical therapy for achalasia is called per oral endoscopic myotomy (POEM). In this procedure, a special endoscope is placed through the mouth and tunneled under the lining of the esophagus. The same muscle layer that is cut during a Heller myotomy is cut from the inside of the esophagus. There are no incisions in the abdomen. However, there is a higher incidence of heartburn and GERD after this procedure than the Heller myotomy. There is also no long-term data as of yet, and most insurances consider the procedure investigational.
Long-term, achalasia surgery is very effective in maintaining swallowing to a point where it is not a significant impact on your overall quality of life. Certain foods, such as steak, dry chicken, or bread may be off the menu for life.
Some patients (10-15%) develop excess acid exposure (GERD) after a Heller myotomy.
Patients with achalasia have a slight increased risk for esophageal cancer. The reason for this is unclear. It is recommended that patients with achalasia have endoscopy with biopsy at intervals (no current standard recommendation as to how frequent) to assess this risk.
Before achalasia surgery: You will be on a clear liquid diet for 48 hours prior to achalasia surgery. This is done because we do not want any food in your esophagus at the time of surgery. Most people with achalasia are otherwise healthy, and there is not much preparation needed, other than testing and confirming the diagnosis. Achalasia surgery takes about an hour to an hour and a half.
After achalasia surgery: Almost all patients are able to be discharged the day of surgery. After achalasia surgery, most patients notice an immediate improvement in the ability to swallow. You will be on a special diet for a few weeks after the surgery until the swelling goes down. Generally, there are no activity restrictions after achalasia surgery.