The Center for Minimally Invasive Esophageal Therapies at Boston Medical Center provides compassionate patient care to you and your family using the most advanced and effective medical treatment in New England. We perform innovative procedures such as myotomy, and will guide you on the path to recovery as quickly and as comfortably as possible.
Treatment options for esophageal conditions vary, but one of the most effective long-term therapies is myotomy, which is a generic term for surgery in which a muscle is cut. In esophageal conditions, the surgeon typically cuts the muscle fibers in the lower esophageal sphincter, or LES, to correct the condition. There are three ways to perform a myotomy:
- Open surgery, by means of thoracotomy or incision. When used to treat achalasia, it is sometimes called a Heller myotomy.
- Laparoscopically, meaning through tiny incisions in the abdomen
- Robotic myotomy, when the surgeon uses the assistance of a robot to perform the procedure
How to Prepare
It is important to follow any instructions given to you by your physician, to prepare for surgery. You will be on a clear liquid diet for 2-3 days before surgery, then no eating or drinking after midnight the night before surgery.Bring all of your medications with you to the hospital and arriving one hour before your surgery. You may have a pre-admission appointment one to two weeks beforehand, at which you will have routine blood testing, any heart or esophageal imaging and consultation with the anesthesiologist, who will administer medicine during your procedure that puts you to sleep and eases pain.
If possible, do some mild physical activity—such as walking—and eat a balanced diet leading up to your scheduled surgery. In the week before, try to follow the guidelines below:
- Limit alcohol consumption to one to two glasses a day.
- Stop using tobacco or cut back on the number of cigarettes you smoke each day.
- Make a list of all medications you take and bring it with you. Include prescription and over-the-counter medications, herbs, supplements, aspirin and corticosteroids.
What to Expect
On the day before your procedure, you should receive a call from us. You will be given information about the day of your myotomy, including where to go and when to arrive. Leave any jewelry, credit cards or other valuables at home, and wear comfortable clothes.
When you arrive, you will be taken to a pre-surgery area so that we can take your temperature, blood pressure, pulse, and listen to your heart and lungs. We will place an intravenous (IV) line in a vein in your arm, so that medications and fluids may be administered before, during and after the procedure.
Myotomy can be done using open surgery/thoracotomy (incision). Once the anesthesiologist has given you medicine, your surgeon makes an incision in your chest and then into the esophagus. He or she cuts the muscle in the way determined before the surgery, based on your condition and situation.
At BMC, we are able to do the procedure laparoscopically as well, which minimizes discomfort, risk of complications and recovery time. A thin, lighted tube called a laparoscope as well as surgical tools are inserted through a catheter into the abdomen. The surgeon uses the tools to make the incision.
Robotic myotomy is the third option we offer. The surgeon guides a robot to perform the procedure. His or her natural hand movements are conveyed to the robot's instruments using a control console and computer.
After surgery, you will be taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate and breathing. An IV line will remain in your arm to keep you hydrated and administer pain medication, if necessary. If a breathing tube was inserted during surgery to control your breathing, it may remain in place for a brief time.
Before you go home, your physician or nurse will teach you how to care for your incision. Gradually, over the course of a few weeks, you will regain your strength and be able to return to work and participate in physical activity. Be sure to call your doctor if you notice any of the following:
- High temperature
- Allergic reaction, such as redness, swelling, trouble breathing
Always take your medicine exactly as prescribed. Call us if you have any questions or changes.