Laparoscopic Heller Myotomy: Stretching and Tearing Technique

Surgical video case: laparoscopic Heller myotomy with anterior fundoplication significantly relieves the symptoms of achalasia without causing the symptoms of gastroesophageal reflux disease. This procedure results in excellent overall patient satisfaction.The myotomy is performed at the 11 o’clock position, typically using hook electrocautery. Many surgeons prefer to separate the longitudinal and circular muscle fibers of the esophagus bluntly after initial scoring sharply with or without electrocautery or with other energy devices such as ultrasonic shears. The myotomy is then extended approximately 6-8 cm cephalad onto the esophagus, across the GEJ, and 2-3 cm onto the stomach.In our experience, we found advantageous and safe performing the myotomy by stretching and tearing the circular muscle fibers with two laparoscopic graspers directed in opposite direction. Once the submucosal plane is reached, the muscular layer is separated bluntly from the submucosa and the stretching myotomy is easily extended proximally and distally. Bleeding from the esophageal musculature is minimal and no attempt is made to diathermy the bleeding.