Cardiomyotomy is operation performed for a condition referred to as Achalasia. In this condition, the muscle at the lower end of the oesophagus (gullet or food pipe) is too thick and too tight. This causes patients with this disorder to have issues with eating and drinking commonly.
The main cause of achalasia is degeneration of the nerve cells within the esophagus (the food pipe). The exact reason why this happens isn’t known.
The loss of nerve cells within the esophagus causes two major issues that interfere with swallowing. Firstly, the muscles that line the esophagus don’t contract normally, so swallowed food isn’t pushed forward through the esophagus and into the abdomen properly.
Secondly the lower esophageal sphincter (LES), a valve created of of muscles, doesn’t relax with swallowing because it does in normal individuals. As a result, the esophagus above the persistently contracted LES starts to dilate, and large volumes of food and saliva can accumulate within the dilated esophagus.
The commonest symptom of achalasia is problem in swallowing. Patients get a sensation that swallowed food as well as liquids get stuck in the chest. This difficulty invariably progresses and becomes severe. Other symptoms include regurgitation of swallowed food and liquid, a sensation of fullness, chest pain, heartburn, or a lump in the throat, hiccups, and weight loss.
This operation is performed under general anaesthesia. The operating surgeon makes a small (1cm) incision in the upper abdomen and introduces a cannula or a tube inside the abdomen. He then inserts a telescope connected to a miniature video camera through the cannula that provides him and the operating team an enlarged view of your internal organs on a video monitor. He will then place four other extra cannulas through little (5mm) cuts to accommodate special long instruments. During surgery, the LES and the muscle layer within the upper part of the abdomen are divided precisely under the enlarged view. As division of LES makes the patient vulnerable to gastro-esophageal reflux, the upper part of the abdomen referred to as fundus is rotated around and fixed in such a way that it creates a fundoplication or a valve. This prevents the acid from the abdomen from coming back into the esophagus.
Advantages of laparoscopic cardiomyotomy
- Shorter hospital stay
- Faster return to normal diet
- Shorter recovery time
- Less pain from the incisions after surgery
- Faster return to work or normal activity
- Better cosmetic healing