Myotomy can be performed as a laparoscopic, thoracoscopic or an open surgery.
- Laparoscopic and thoracoscopic myotomies are minimally invasive procedures. They involve small surgical cuts through which a thin tube-like device is inserted into the body. The device has a tiny camera at one end that enables the surgeon to view the inside of the body and operate. Thus, a large cut is avoided.
- In thoracoscopic myotomy of the lower esophageal sphincter, the surgeon performs the surgery by passing a thin tube-like device called thoracoscope through the patient’s chest.
- A thoracoscopic myotomy requires an anti-reflux procedure to prevent regurgitation. It is more difficult to perform. This problem is not encountered with laparoscopic techniques.
- In a laparoscopic myotomy, the device, called a laparoscope, is passed through the patient’s abdomen
- Laparoscopic myotomy allows better visualization for the surgeon as compared to a thoracoscopic myotomy.
- Myotomies in patients with severe achalasia need more time, which is possible in laparoscopic myotomy because it is a longer procedure than thoracoscopic surgery.
- Long-term outcomes and success rates are higher with laparoscopic myotomies than those with thoracoscopic myotomies.
- Postoperative complications, especially reflux or regurgitation, are higher in a thoracoscopic myotomy as compared to a laparoscopic procedure.
What is an esophageal myotomy surgery?
Esophageal myotomy is a surgical procedure to loosen the tight valve between the food pipe (esophagus) and the stomach. The thick muscle of the lower part of the esophagus and the upper part of the stomach is cut to relieve the difficulty in swallowing (dysphagia). This condition occurs when the lower esophageal sphincter fails to relax properly (achalasia). It is an uncommon disorder of the esophagus characterized by inadequate relaxation of the lower esophageal muscle, and the loss of motility. Achalasia causes difficulty in pushing the swallowed food into the stomach. This is commonly seen in young people, age ranging from teens to 30s, and they present with:
- Dysphagia (difficulty in swallowing) for both solids and liquids at the same time
- Regurgitation (the swallowed food is pushed back into the oral cavity)
- Dry cough
- Chest pain
- Weight loss
An esophageal myotomy surgery provides relief from achalasia by disrupting the muscles of the lower esophageal sphincter to relax the esophagus and allow passage for food.
When will I be able to eat after a myotomy surgery?
You will be able to have liquids on the evening of your operation. You will be then advanced to a soft diet and discharged from the hospital the following day. Your doctor may give you medications to prevent nausea besides painkillers and antibiotics. You will be advised to avoid strenuous activity and heavy lifting for four to six weeks. You may be able to resume normal activities within one to two weeks and a regular diet in two to six weeks after the surgery.
What are the complications of a thoracoscopic and laparoscopic myotomy surgery?
Complications are similar in both thoracoscopic and laparoscopic myotomies, however, certain complications, such as reflux, may be more frequent in case of a thoracoscopic myotomy.
The complications of a myotomy surgery include:
- Esophageal perforation or hole
- Pneumothorax (presence of air between the lungs and the chest wall)
- Nerve injury
- Spleen injury
- Dysphagia (difficulty in swallowing)
- Scarring in the lower part of the esophagus or the upper part of the stomach
- Stricture formation (areas of abnormal narrowing of the esophagus or the stomach)