Achalasia Cardia/ Laparoscopic Heller’s Cardio-Myotomy in Mumbai, India
Achalasia Cardia is a primary motility disorder that affects the food-pipe. It affects approximately 6 people per 100,000 population per year. In this disease mainly the lower end of the food-pipe also called as the lower oesophageal sphincter (LES) fails to relax and leads to functional obstruction. This is said to be caused due to neurogenic degeneration which can be idiopathic or secondary to an infection.
Few other conditions may also mimic achalasia. These are- a tight stricture/narrowing in the lower end of the food-pipe, cancer of the lower end of the food-pipe or a tight wrap of stomach after a laparoscopic anti-reflux surgery like fundoplication.
- Inability to swallow food and water
- Regurgitation of un-digested food
- Chest pain
- Weight loss
- Breathlessness, cough, asthma like symptoms
How is Achalasia Cardia diagnosed?
- X Ray Chest: A simple X Ray chest may show an air-fluid level in the food-pipe
- Barium swallow: shows a dilated and sometimes tortuous food-pipe with a typical “bird-beak” narrowing of the lower end of the food-pipe.
- Oesophageal manometry: helps to measure the rhythmic muscle contractions of the food—pipe after swallowing, the coordination and force exerted by its muscles, and how well does the lower oesophageal sphincter relaxes or opens during a swallow. This test also helps to differentiate from other motility disorders of the food-pipe.
- Upper GI Endoscopy: This test is performed by inserting an endoscope through the mouth, via the food-pipe into the stomach. It helps to visualize the internal part of the food-pipe and the stomach. During endoscopy, a biopsy can also be taken if needed.
How is Achalasia Cardia treated?
- Medications: medications may sometimes be used to relax the lower oesophageal sphincter. However, they have not shown very good or long-lasting results. Usually, they are prescribed in early stages or to people who are medically unfit to undergo any kind of procedure.
- Endoscopic balloon dilatation: Mechanical pneumatic dilatation is done to rupture the circular muscles of the lower oesophageal sphincter. Fairly good results have been seen after this procedure and are said to be long lasting too. In 2% cases, oesophageal perforation may occur as a complication.
- Peroral endoscopic myotomy (POEM): In this procedure, an endoscope is introduced through the mouth into the food-pipe. Internally an incision is made on the internal lining of the food-pipe until the muscle of the LES is cut. Some patients may develop acid reflux after POEM and may need a fundoplication operation if not able to control on medications.
- Laparoscopic Heller’s cardio-myotomy: This operation was originally described by Heller in 1914. Modern version of this operation involves a myotomy on the anterior aspect of the lower end of the food-pipe. It is accompanied with a partial wrap of the stomach to prevent acid reflux later on. This operation has shown very good results in over 90% of cases over ten years follow up.
What is the diet post Laparoscopic Heller’s Cardio-myotomy?
- After a Laparoscopic Heller’s Cardio-myotomy, you will be fasting for the first 24 hours.
- Liquids are started orally from the next day and are continued for 48 to 72 hours.
- Post that soft diet is commenced and continued for another 3 to 4 days after which solid food is allowed.
For how many days do I need to stay in the hospital?
Most patients get discharged within 48 to 72 hours after the surgery.
How can I schedule an appointment?
To schedule an appointment please click on Contact us or call us on +919819566618.
Cost of Laparoscopic Heller’s Cardio-myotomy
Cost of laparoscopic Heller’s Cardio-myotomy depends on the hospital in which the surgery is being conducted. It also depends on the room type that you may select. It can be done in an affordable and safe manner.
Is this surgery covered by health insurance?
Yes, a Laparoscopic Heller’s Cardio-myotomy surgery is covered by health insurance. You may choose to go in for a cashless procedure or avail re-imbursement after the surgery.
Who will be my surgeon?
Dr. Aparna Govil Bhasker is an accomplished laparoscopic and bariatric surgeon. She performs surgery along with her team.