Oesophageal myotomy (or Heller myotomy) is a procedure that can be performed to treat a lower oesophageal sphincter (LES) that fails to relax (e.g. achalasia). The procedure involves a longitudinal incision of the distal oesophageal musculature to break the sphincter tone.
A fundoplication wrap can be performed to restore some patency to the lower oesophageal sphincter. A section of the gastric fundus is wrapped around the gastro-oesophageal sphincter to mechanically apply some tone to the junction. There are several variations, including
- Nissen fundoplication: the gastric fundus is passed behind the distal 6 cm of the oesophagus and a 360° wrap is performed by pulling some of the fundus anteriorly as well and attaching the two ends anteriorly
- Toupet fundoplication: Similar to a Nissen, but a 270° wrap
- Dor fundoplication: the fundus is pulled anteriorly <180°
A more recent technique of per-oral oesophageal myotomy (POEM) is increasing in use in some centers.
Fluoroscopy: barium swallow
- there may be characteristic "ballooning" of the distal oesophagus after a myotomy (50%), as the oesophagus bulges through the myotomy 3-4
- 1. Zaninotto G, Attwood SE. Surgical management of refractory gastro-oesophageal reflux. Br J Surg. 2010;97 (2): 139-40. doi:10.1002/bjs.6863 - Pubmed citation
- 2. Gore RM, Levine MS. Textbook of Gastrointestinal Radiology, 2-Volume Set, 4e. Saunders. ISBN:1455751170. Read it at Google Books - Find it at Amazon
- 3. Rubesin SE, Kennedy M, Levine MS et-al. Distal esophageal ballooning following Heller myotomy. Radiology. 1988;167 (2): 345-7. doi:10.1148/radiology.167.2.3357942 - Pubmed citation
- 4. Barker JR, Franklin RH. Heller's operation for achalasia of the cardia. A study of the early and late results. Br J Surg. 1971;58 (6): 466-8. Pubmed citation