✦ ACHALASIA CARDIA · OPEN SURGERY

Heller Myotomy (Open)

Q: Does Heller Myotomy cure achalasia permanently?

It permanently relieves the LES obstruction in 90%+ of patients. While the underlying nerve degeneration cannot be reversed, the obstruction is permanently resolved.

Q: Why is a fundoplication added?

Dividing the LES removes the anti-reflux barrier. A partial Dor or Toupet wrap recreates a functional anti-reflux mechanism.

Q: What if symptoms return after myotomy?

Recurrence in a small minority is managed by pneumatic dilation, repeat myotomy, or POEM. Dr. Grandhi will assess the most appropriate approach individually.

Open surgical division of the lower oesophageal sphincter — definitive treatment for achalasia cardia.

90–150 Min TREATMENT DURATION

3–5 Days CARE SETTING

Open APPROACH

3–4 Weeks RECOVERY TIMELINE

What is Heller Myotomy (Open)?

Achalasia Cardia is a rare oesophageal motility disorder where the lower oesophageal sphincter (LES) fails to relax during swallowing, causing food to accumulate in the oesophagus. Heller Myotomy precisely divides the LES muscle fibres, permanently relieving this obstruction. Dr. Tagore Mohan Grandhi performs Heller Myotomy. A partial fundoplication is added to prevent post-operative acid reflux. The open approach provides direct control for complex or revision cases with over 90% long-term success.

Suitable for patients with confirmed achalasia on high-resolution manometry (bird-beak sign on barium swallow), particularly complex cases, previous interventions, or where a laparoscopic approach is not possible.

How the Procedure Works

Pre-operative Confirmation

High-resolution manometry confirms absent peristalsis. Barium swallow shows bird-beak sign. Endoscopy excludes pseudoachalasia or malignancy.

Surgical Access

Open approach through upper midline incision. Full exposure of the gastro-oesophageal junction achieved under direct vision.

Myotomy

LES muscle fibres divided longitudinally — 6 cm on the oesophagus and 2 cm onto the stomach — under direct vision. Mucosal integrity confirmed.

Partial Fundoplication

Dor (anterior) or Toupet (posterior) partial fundoplication added to restore the anti-reflux mechanism without impairing the myotomy benefit.

Recovery

Liquid diet from day two. Dietary advancement over 4–6 weeks. Immediate swallowing improvement noted from day of surgery.

Outcomes

90–150 MinTREATMENT DURATION

3–5 DaysCARE SETTING

OpenAPPROACH

3–4 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Direct tactile control — ideal for complex, recurrent, or revision achalasia cases
→90%+ long-term swallowing relief — most durable achalasia treatment
→Partial fundoplication prevents post-operative acid reflux
→Permanent relief — no repeat procedures in the vast majority of patients

Heller Myotomy gives achalasia patients their swallowing and quality of life back. Most are amazed by how quickly food passes normally after years of struggling.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Does Heller Myotomy cure achalasia permanently?+

Why is a fundoplication added?+

What if symptoms return after myotomy?+

Not sure which treatment is right for you?

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