Achalasia (Laparoscopic Cardiomyotomy)

Achalasia refers to a condition when smooth muscle fibers of the oesophagus fail to relax, permitting the normal passage of food into the stomach. This leads to a backup of food within the oesophagus, which can cause severe irritation in the throat.

Causes and Risk Factors of Achalasia

It is not easy to pinpoint the cause of achalasia. It could be genetic, or the result of an autoimmune condition, which occurs when your body’s immune system attacks healthy cells in the body by mistake. It can also be caused by a rare parasitic infection called Chagas’ disease.

Achalasia is more common with middle-age and elderly people, though it has been noted in children in some rare cases. It is also more common in people with autoimmune disorders.

Symptoms of Achalasia

The most common achalasia symptom is difficulty in swallowing. This can lead to numerous symptoms such as coughing, aspiration, and choking on food. Other achalasia symptoms include:

  • pain or discomfort in your chest
  • weight loss
  • heartburn
  • intense pain or discomfort after eating

Achalasia Diagnosis

When you have trouble swallowing, the doctor might suspect achalasia. They will use oesophageal manometry and pH monitoring, which involves the insertion of a tube in your oesophagus while you swallow. The tube records the muscle activity and acid levels to assess how your oesophagus is working. The doctor may perform an upper GI endoscopy to exclude any blockages such as tumours.

Achalasia Treatment (endoscopic or laparoscopic cardiomyotomy)

Non-surgical treatments include botox injections or balloon dilation, which may provide relief for some time. However, the tightness often recurs.

The more durable solution for achalasia is a cardiomyotomy procedure. This may be performed by the endoscopic or laparoscopic route.

How is Laparoscopic Cardiomyotomy Performed?

Laparoscopic Cardiomyotomy is performed under general anaesthesia. The doctor will make keyhole punctures into the upper abdomen, and introduce laparoscopic tools. The muscle layer of the lower oesophagus and upper stomach is divided lengthwise. This tends to make patients susceptible to acid reflux after surgery, so the surgeon will usually rotate the upper part of the stomach and fix it so that it creates a valve which will prevent the acid from the stomach from coming back into the oesophagus. This manoeuvre is called a fundoplication.

Post Laparoscopic Cardiomyotomy

There might be some abdominal discomfort or nausea for about 12 to 24 hours after cardiomyotomy. The doctor will prescribe medication to take care of this side effects.

You can drink fluids within 6 to 8 hours of surgery, and will usually be discharged from the hospital within 48 – 72 hours after the surgery. The usual recovery time is 10 – 15 days. Your doctor will advise you to follow a soft diet for 2 – 4 weeks after surgery, to allow proper healing.