Achalasia is a rare disease of the lower esophageal muscle which can cause a person to have difficulty in swallowing, also known as dysphagia. Other symptoms include chest pain and regurgitation of food and liquids. The condition is a tightening of the lower esophagus and lower esophageal sphincter (LES), where food is unable to pass into the stomach. Achalasia is also associated with abnormal or absent peristalsis, which is the coordinated muscle actions that moves food from the throat to the stomach.
Patients usually report decreasing ability to swallow, regurgitation, chest pain and weight loss. The condition often goes undiagnosed for months or even years as people will modify their eating behaviors to ease the symptoms for themselves. However, when the difficulty in swallowing becomes too much, the patient will make an appointment with the doctor to diagnose and treat the issue. Some of the tests employed by physicians to diagnose the condition include x-rays, esophageal manometry, and endoscopy.
The first treatment steps are medications or for Botox® to be injected to weaken the muscles. However, in cases where more conservative treatment is not effective, a surgeon may be needed to perform a laparoscopic Heller Myotomy. This minimally invasive treatment physically opens the tight LES by cutting the thicker muscle of the lower esophagus and upper stomach, relieving the dysphagia. In some cases, the surgeon may perform a Dor fundoplication, where the stomach is wrapped partially around the esophagus to make a lower pressure valve to prevent reflux symptoms.
Most patients stay overnight following a Heller Myotomy and a swallow test will be completed in the morning. Patients will not be discharged until they are able to swallow. Patients will be able to resume most activities soon after surgery. It will be important to avoid any heavy lifting or strenuous activity until the surgeon gives you the all clear. Patients will need to follow a modified diet to aid in recovery, starting with only consuming small amounts of clear liquid foods, before progressing to other liquids and soft foods. Laparoscopic procedures have minimal incisions and the post surgical dressings will be removed approximately 48 hours after surgery. Most patients only experience minimal discomfort following a laparoscopic surgery.
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