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VCU Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University VCU Division of Cardiothoracic Surgery VCU Medical Center VCU

VCU Division of Cardiothoracic Surgery

Laparoscopic Heller Myotomy and Dor Fundoplication

What does the operation consist of?

The operation is performed by laparoscopy (camera surgery, small incisions).  It involves cutting the LES muscle that does not relax.  Care has to be taken not to injure the inner layer of the esophageal wall (mucosa).   The second part involves creating a partial wrap of the stomach around the lower esophagus to help reduce the rate of post surgery heartburn.

There is no treatment for the loss of esophageal squeeze function.  By cutting the LES muscle, the passage of food is easier through the esophagus into the stomach.

Important surgical points
  • The nerves supplying the stomach and liver are preserved during the procedure.
  • The surgery is 1-2 hours long and is performed under a general anesthetic.
  • Patients are up and walking the same day
  • The cutting of the muscle is done very carefully to avoid injuring the inner layer of the esophagus
  • A complete fundoplication is not done since the esophagus does not have any squeeze function
Care after Heller Myotomy
  • Patients go home on a liquid diet that can be advanced to a regular diet in a week
  • Patients are given pain medications after the surgery to take by mouth as needed
  • Constipation is to be avoided after the surgery
  • We advise patients not to engage in strenuous activity or heavy lifting (more than 10 lbs) for 4 weeks after surgery
  • Most patients are off pain medications after 7-10 days and can go back to work in 2-3 weeks
  • All patients after surgery receive a DIETERY CONSULTATION in the hospital to go over their food choices, recommended diet and answer your questions
  • Patients are advised not to drink carbonated beverages after the procedure
Side effects after Heller Myotomy

The physiologic function of the LES is to prevent reflux.  It is cut during the myotomy to allow food to pass.  Since the LES can not close anymore, patients may develop some reflux.  However, it is significantly reduced by the addition of a fundoplication and less than 10% of patients have reflux, usually mild afterwards.


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