End Result of Laparoscopic Heller Myotomy Adequate Muscle Separation and Mucosal Exposure

This short video demonstrates the final outcome of laparoscopic Heller myotomy after complete separation of the circular and longitudinal muscle fibers of the esophagus. The myotomy is extended approximately 6–8 cm proximally over the esophagus and 1–1.5 cm distally onto the gastric cardia to ensure adequate relief of the functional obstruction. Careful division of both muscle layers allows full exposure of the underlying mucosa without residual muscle fibers. The integrity of the mucosa is a critical endpoint of the procedure and must be confirmed at this stage. Mucosal safety can be assessed by intraoperative endoscopy and by instillation of methylene blue to detect any occult thermal injury or perforation. The absence of dye leakage and a smooth, intact mucosal surface confirm a complete and safe myotomy. This final view highlights the anatomical and functional goals of an effective Heller myotomy.