Achalasia: food does not pass into the stomach
With achalasia cardia, the work of the lower esophageal sphincter is disrupted: normally it relaxes when swallowing, allowing food into the stomach, but with this disease it remains spasmodic. At the same time, esophageal peristalsis disappears. As a result, food is retained, the esophagus gradually expands, and the person experiences difficulty swallowing first solid and then liquid food, regurgitation of undigested food, chest pain and weight loss.
The diagnosis is made based on a combination of barium fluoroscopy, where the esophagus is dilated and narrowed downward in the form of a “bird’s beak,” endoscopy, which excludes a tumor, and manometry, which confirms the absence of sphincter relaxation. Medications and balloon dilatation provide a temporary effect and require repetition.
Heller's operation solves the problem radically: the muscular layer of the sphincter is cut longitudinally over 6–8 centimeters, while the mucous membrane remains intact. The lumen is cleared and food passes freely. Since the dissected sphincter no longer holds the stomach contents, myotomy is always complemented by partial fundoplication - the creation of a cuff from the fundus of the stomach, preventing reflux. The laparoscopic approach provides good long-term results in the vast majority of patients.
Advantages of laparoscopic approach
Instead of a 10–20 centimeter long incision, 3–4 punctures ranging in size from 5 to 12 millimeters are made. This reduces pain after surgery, reduces the need for painkillers, speeds up the recovery of bowel function and allows you to be discharged much earlier.
The cosmetic result is no less important: puncture marks become almost invisible over time. The incidence of postoperative hernias and adhesions is also reduced, since the abdominal wall and internal organs are less injured.
When laparoscopy is not possible
Limitations include a pronounced adhesive process after previous operations, severe heart and lung diseases in which the injection of gas into the abdominal cavity is poorly tolerated, blood clotting disorders and extreme obesity.
Sometimes the decision is made already during the operation: if the anatomy does not allow working safely, the surgeon switches to an open approach. This is not a complication, but a provided option, about which the patient is warned in advance.
What happens after discharge
In the first weeks, fractional meals, sufficient amounts of fluid and a gradual expansion of the motor regime are recommended. Heavy loads, saunas and swimming pools are avoided until healing.
Reasons to immediately consult a doctor include fever, increasing abdominal pain, redness and discharge from punctures, nausea and vomiting, retention of stool and gas.