Laparoscopic Achalasia cardia

Achalasia usually is caused by the degeneration of nerve cells in the esophagus, the food pipe. Due to this the patient has difficulty in swallowing. the loss of nerve cells causes interference in swallowing the food and drink as the muscles that line the esophagus do not contract normally. Also, the swallowed offd is not pushed forward through the food pipe and stomach in a proper condition. The condition though cannot be cured, the same can only be treated by relieving the symptoms. The ingested food or drink gets collected in the food-pipe showing the symptoms of blockage behind the chest bone. The Sphincter muscle (a valve also known as Lower Esophageal Sphincter (LES)) starts to dilate as it does not relax. And hence, the quantity of food and saliva can accumulate in the dilated Esophagus.

Symptoms:

Major symptoms are:

  • Swallowing of Food or drink
  • Inhaling or Choking of Food

Apart from these, the following symptoms may also be experienced:

  • pain or discomfort in the chest
  • weight loss
  • heartburn
  • intense pain or discomfort after eating
  • Sensation of fullness or lump in throat
  • Hiccups

Diagnosis:

Apart from the major symptoms, there are certain investigation tests to confirm the diagnosis.

Barium swallow

In this investigation, a milky liquid of Barium is swallowed and X-Rays are performed. The achalasia patient shall show the narrowing region at the lower end of the esophagus with a dilated esophagus above.

Manometry

A thin tube is passed through the mouth or nose into the esophagus (food pipe). There are numerous pressure sensors lined on the tube that convey pressure in the esophagus attached to a device. As per the muscle contractions, the changes in the pressure are measured in the esophagus. This investigation is mostly used to confirm the diagnosis.

Endoscopy

A thin, flexible tube is passed via mouth to see the esophagus, Lower Esophageal Sphincter (LES) and stomach region. Intravenous sedatives are usually given to the patients during endoscopy.

Treatment

Laparascopy for Achalasia Cardia / Achalasia is the most effective procedure. Also known as “Hellers Cardiomyotomy” the tight muscle at the lower end of the oesophagus is divided, which allows this part of the oesophagus to widen therefore allowing food and fluid to more easily pass into the stomach.

This procedure is performed by ‘Keyhole Surgery’. Approximately 5 tiny hole incisions each less than half an inch are made on the abdominal area. This procedure is performed under General Anesthesia. It may be combined with the Anti-reflux procedure as well as the division of the LES (Lower Esophageal Sphincter) can make the patient prone to gastro-esophageal reflux. In this procedure, the upper part of the stomach which is known as Fundus, is rotated and fixed to create a valve, which prevents the acid from the stomach from coming back to esophagus.

The duration of the procedure is around one hour to one and half hour (60-90 minutes)

Can I opt for this surgery?

A doctor takes in to consideration your health background, body structure, waist circumference and BMI to decide is this surgery is good for you or not. However, if your BMI is over 30 and your waist is 101 cm (men) and 89 cm (women), you may be a candidate for this surgery. This surgery is mostly recommended to seriously obese patients.

Post Procedure

  • A small amount of pain for about 12-24 hours may be experienced after Laparoscopic Achalasia Cardia which again depends upon the individual in terms of tolerating pain.
  • Nausea and vomiting may be felt in the initial 12 hours due to the effect of General Anesthesia.
  • Painkillers and other medications are given to take care of pain and nausea.
  • Patient would be allowed to drink fluids within 6 hours of surgery and may be some soft blend diet a day after the procedure.
  • Most patients are allowed to go home within 2 – 3 days and can recover completely within 10-15 days. However, normal routine work including light, desk jobs can be resumed within a few days.
  • The patients are advised to follow blenderized diet for around 6 weeks to allow the area of surgery be healed. After that, the patient is allowed to eat normal diet.
  • Regular follow-up after the procedure is recommended so as to recognize and treat any recurrent symptoms or complications of treatment.

Advantages of Laparoscopic Cardiomyotomy

  • Minimal invasive procedure hence less pain from the incisions
  • Better healing, cosmetically as well as physically
  • Resuming to routine work and normal activities is faster
  • Can resume to Normal diet within a few days
  • Recovery time is shorter
  • Less Hospital stay of around 48-72 hours only