Laparoscopic Treatment for Achalasia Cardia: Symptoms, Procedure, and Recovery

What Are the Symptoms of Achalasia Cardia?

The symptoms of achalasia cardia do not develop all of a sudden. They tend to affect individuals over months or years. Sometimes, individuals also mistake the signs for acid reflux or other digestive disorders, especially during the early years.

• Difficulty in swallowing foods and eventually liquids
• A feeling of something being choked in the chest
• Regurgitation of undigested food, especially when lying down
• Chest discomfort after eating
• Frequent coughing that does not go away
• Bad breath due to retained food
• Unintended weight loss
• Repeated chest infections due to aspiration of food into the lungs

Patients who have been experiencing these symptoms for quite a long time should get themselves evaluated by an achalasia cardia surgeon like Dr. Purnendu Bhowmik for an improved treatment outcome.

Diagnosis of Achalasia Cardia Treatment

Before recommending the most appropriate achalasia cardia treatment, healthcare professionals conduct several tests to confirm the diagnosis.

Upper endoscopy: The procedure involves using a tiny camera at the end of a flexible tube to rule out structural abnormalities in the esophagus.
Esophageal manometry: It measures how well the muscles are contracting in the esophagus during swallowing.
Barium swallow X-ray: The test is conducted after drinking a chalky liquid known as barium, which coats the inside lining of the digestive tract and fills the digestive organs. This coating allows the doctors to view the esophagus, stomach and upper intestine.
Functional luminal imaging probe (FLIP) technology: It is a minimally invasive balloon-based endoscopic tool to find how easily and widely the esophagogastric junction (EGJ) opens.

Once the cause is confirmed, achalasia cardia treatment approach focuses on reducing the abnormal pressure on the lower esophageal sphincter and making swallowing easier.

Advanced Achalasia Cardia Treatment

The most effective, safe, and long-term treatment for achalasia cardia is a laparoscopic Heller's myotomy. It is the most popular achalasia cardia treatment because of improved morbidity and quicker recovery time.

The procedure is performed using laparoscopic techniques, which means tiny incisions are made to cut the thickened muscle of the lower esophageal sphincter so food can easily pass into the stomach.

It is then followed by partial fundoplication, which is performed by wrapping a portion of the stomach around the lower esophagus to minimise postoperative acid reflux.

The success of laparoscopic Heller's myotomy lies in its ability to completely divide the LES circular muscle fibre, combined with an anti-reflux procedure to prevent post-operative heartburn.

Whenever an individual suffers from achalasia cardia, the LES fails to relax because the nerve cells that tell the muscles to open are either damaged or closed.

As a result, the esophagus acts like a closed door or a blocked pipe, causing the foods and liquids to accumulate and leading to symptoms such as difficulty in swallowing and regurgitation.

Traditional approaches like pneumatic dilatation stretch the LES temporarily, which again gets tightened over time. However, achalasia cardia treatment involving laparoscopic Heller's myotomy takes a different approach.

The procedure permanently divides the muscle fibres that are responsible for the blockage. This, in turn, lowers the resistance at the junction of the esophagus and stomach.

While there is no cure to reverse the damaged nerves, reducing the obstruction allows the food to pass through the stomach more efficiently. As a result, patients experience smoother swallowing, reduced regurgitation, improved nutrition, and a much better quality of life.

Laparoscopic Surgery vs. Temporary Treatments

There are several achalasia cardia treatment modalities.

Pharmacotherapy: They are generally temporary options and slightly relax the LES. Medicines provide limited benefit and rarely control symptoms in moderate cases.
Botox Injections: The technique involves pushing a maximum of 100 units of botulinum toxin to temporarily relax the LES by weakening the muscles.
Pneumatic Dilation: It is the most effective non-invasive treatment where a balloon is inflated and inserted to stretch the LES muscles. However, the results are for the time being, and the muscles tend to regain their tightness.

Advantages of Laparoscopic Surgical Intervention

Laparoscopic Heller's myotomy offers several benefits over conventional methods. Dr. Purnendu Bhowmik states some of the following.

• Treats the underlying condition
• Provides a long-term solution
• Smaller incisions
• No post-operative pain
• Reduced blood loss
• No visible scarring
• No need for repeated procedures
• No complications
• Decreased risk of wound infections
• Improve long-term comfort

Recovery after laparoscopic Heller's Myotomy

Recovery after laparoscopic Heller's myotomy is usually faster than with the open method. Patients are able to return to their daily activities within a few days. Complete healing usually takes a few weeks, although swallowing difficulties start improving one or two days after the surgery.

A shorter healing time is probably one of the advantages of laparoscopic achalasia cardia treatment. However, Dr. Purnendu Bhomwik advises patients to adhere to post-operative instructions regarding diet, exercise and pain management.

Conclusion

Achalasia cardia is a progressive swallowing disorder. Fortunately, advancements in achalasia cardia treatment have made it possible for patients to restore the ability to swallow comfortably and regain better control of their lives.

You can book your appointment with Dr. Purnendu Bhowmik for accurate treatment approaches.