General and Gastrointestinal Surgery

Surgery Options Q and A

How long do I stay in the hospital after an open esophageal myotomy?

Patients remain in the hospital for 4 to 6 days after the operation.  The primary reason  is postoperative discomfort; patients who have less discomfort may be discharged on the second or third day after surgery.

What is the recuperation period for an open esophageal myotomy?

After discharge, patients begin to resume normal activities except heavy lifting or driving. Patients should not drive  or make important decisions while taking narcotics.  Within 2 weeks, most patients can drive and by 4 to 6 weeks they can return to work and heavy lifting.

What is the laparoscopic approach for achalasia?

Rather than making a large incision and looking directly into the abdomen, laparoscopic surgery makes small incisions of 5 to 10 mm (1/5 to 2/5 inches) and uses a telescope to see the abdomen.  The scope is attached to a camera that allows surgeons to operate while watching on a television screen.  A laparoscopic myotomy requires two incisions of  5 mm (1/5 of inch) and three that are 10 mm (2/5 of inch).  Tubes are passed through these incisions to allow access into the abdomen. Surgery is performed using instruments passed through the small tubes.

How long does a laparoscopic Heller myotomy take?

Usually the operation takes from one to two hours.  The longer operations usually result when an anti-reflux operation is combined with the myotomy.

Can I go home the same day?

Patients stay in the hospital overnight, so they can be monitored for rare complications such as bleeding or perforation.  Most patients go home the following day,  after they obtain an upper GI series, drink liquids and eat soft foods.

What is the recuperation for laparoscopic myotomy?

The major advantage of laparoscopic surgery over open conventional surgery is the significantly shorter recuperative period.  This derives from the smaller incisions used.  A few patients are able to perform normal activities the day they go home but most people require 2 to 3 days to return to normal.  In addition, although some patients return to work in 3 to 4 days, most return back 2 to 3 weeks after surgery.

Why is there an open approach and a laparoscopic approach?

The laparoscopic approach was introduced in the early 1990s based on the success observed with laparoscopic gallbladder removal.  Studies to date have shown less pain, earlier return to normal activities and earlier return to work for the laparoscopic approach.  It is important to recognize that everyone is different in regard to the perception of pain: One person may undergo an open Heller myotomy and return to work in a couple of weeks while another person undergoing a laparoscopic myotomy returns to work in 6 weeks.

Which is a better approach, the open or the laparoscopic?

The actual operation performed during a laparoscopic or open approach is the same; namely dividing the lower esophageal sphincter muscle.  The laparoscopic approach is preferable based on the earlier discharge after surgery, the shorter recovery time, and smaller scarring.  There appears to be no difference in complication rates between the two procedures.

Can all patients have a laparoscopic myotomy?

Most patients requiring a myotomy can undergo the procedure laparoscopically.  Occasionally, it is not possible to complete the operation laparoscopically.  In this situation, the operation is converted to an open procedure.  Overall, more than 95 percent of patients can undergo a successful laparoscopic myotomy.

When must a laparoscopic procedure be converted to an open procedure?

A variety of factors decrease the chance of the surgeon being able to complete the procedure laparoscopically.  These include: inflammation, previous surgery, unclear anatomy, previously unrecognized abnormalities, or an intraoperative problem such as bleeding or perforation.  Conversion of a laparoscopic procedure to an open one should not be viewed as a complication, since some patients simply are unable to have the surgery performed laparoscopically without undue risk.  The goal is to perform a safe and uncomplicated procedure, so no unnecessary risks will be taken merely to complete the procedure laparoscopically.

Do all surgeons perform both the laparoscopic and open approaches?

All surgeons perform the open approach but only some surgeons perform the laparoscopic approach.  Before surgery is scheduled, find out whether the surgeon performs one or both approaches and how many of each he or she has performed.

Risks of surgery