This video ovarian Laparoscopic Heller myotomy is a minimally invasive procedure that opens the tight lower esophageal sphincter (the valve between the esophagus and the stomach) by performing a myotomy (cutting the thick muscle of the lower part of the esophagus and the upper part of the stomach) to relieve the dysphagia

Laparoscopic Heller’s Myotomy (LHM) is a well-established minimally invasive surgical procedure for the treatment of achalasia, a primary esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis. At World Laparoscopy Hospital (WLH), this procedure is taught and performed using advanced laparoscopic principles, emphasizing precision, safety, and excellent functional outcomes.

Achalasia is a chronic neurodegenerative disorder affecting esophageal motility. The disease leads to progressive dysphagia, regurgitation, chest pain, and weight loss due to functional obstruction at the LES. The underlying pathology involves degeneration of ganglion cells, resulting in absence of peristalsis and elevated LES pressure.

All available treatments aim to reduce LES pressure to allow smooth passage of food into the stomach. Among these, laparoscopic Heller’s myotomy has become the gold standard surgical therapy because of its effectiveness and minimally invasive nature.

At WLH, surgeons are trained to perform LHM with precision using modern laparoscopic instruments and high-definition imaging systems.

Principle of Laparoscopic Heller’s Myotomy

The procedure involves division of circular muscle fibers of the distal esophagus and proximal stomach to relieve functional obstruction at the gastroesophageal junction. It is typically combined with partial fundoplication (Dor or Toupet) to prevent postoperative reflux.

The laparoscopic approach uses small incisions, a camera, and specialized instruments, offering better visualization and faster recovery compared with open surgery.

Indications

Laparoscopic Heller’s myotomy is recommended in patients with:

• Symptomatic achalasia with dysphagia

• Failure of medical therapy, pneumatic dilation, or Botox therapy

• Recurrent symptoms after endoscopic therapy

• Patients fit for general anesthesia

Most patients undergo surgery when non-surgical treatments fail, and symptom relief is achieved in approximately 87–92% of cases.

Preoperative Evaluation

At advanced laparoscopic centers such as WLH, evaluation includes:

• Upper GI endoscopy

• Esophageal manometry (gold standard diagnostic test)

• Barium swallow study

• Nutritional and anesthetic assessment

These investigations confirm diagnosis and help plan myotomy length and surgical approach.

Surgical Steps (Standard Laparoscopic Technique)

1. Patient Positioning

• Supine with reverse Trendelenburg position

2. Port Placement

• Usually 4–5 laparoscopic ports placed in upper abdomen

3. Exposure of Gastroesophageal Junction

• Division of phrenoesophageal ligament

• Mobilization of distal esophagus

4. Myotomy Creation

• Longitudinal incision of esophageal muscle fibers

• Extension proximally (esophagus) and distally onto stomach (critical for success)

Incomplete distal extension is a major cause of persistent dysphagia.

5. Fundoplication

• Partial anterior (Dor) or posterior (Toupet) fundoplication performed to prevent reflux

6. Hemostasis and Closure

• Check mucosal integrity

• Remove ports and close incisions

Advantages of Laparoscopic Approach

Compared to open surgery, LHM offers:

• Less postoperative pain

• Short hospital stay (~3 days average)

• Faster recovery and early return to activities

• Better cosmetic outcome

• High patient satisfaction

Studies show significant reduction in LES pressure and durable symptom relief after surgery.

Outcomes and Success Rates

Clinical studies demonstrate:

• Dysphagia relief in more than 90% of patients

• Long-term success maintained in most patients for years

• Durable symptom relief in ~78–85% even at long follow-up

 

Another series reported excellent or good outcomes in about 95% of patients.

Postoperative Care and Recovery

Typical recovery pathway includes:

• Day 1–2: Clear liquids

• Week 1: Soft or semi-solid diet

• Gradual transition to solid diet

Most patients resume normal activity within weeks, though esophageal swelling may take about two months to resolve fully.

Complications

Although safe, possible complications include:

• Mucosal perforation (usually repaired laparoscopically)

• Gastroesophageal reflux disease (GERD)

• Bleeding or infection

• Recurrent dysphagia

Role of Training at World Laparoscopy Hospital

World Laparoscopy Hospital is internationally recognized for training surgeons in advanced minimal access surgery. Training emphasizes:

• Step-by-step surgical standardization

• Simulation and hands-on training

• Advanced energy devices and suturing skills

• Evidence-based laparoscopic techniques

WLH focuses on producing surgeons capable of performing complex procedures like LHM safely and effectively.

Conclusion

Laparoscopic Heller’s Myotomy is a highly effective and durable treatment for achalasia. By relieving LES obstruction while preserving esophageal function, it significantly improves patient quality of life. With high success rates, minimal complications, and rapid recovery, LHM remains the gold standard surgical therapy worldwide.