Gastric Sleeve Surgery after Heller Myotomy

Rebecca from Houston Sent us this question: “I’ve already has achalasia surgery 10 years ago where the stomach lining was wrapped around the esophagus can I still have a gastric bypass and if so, can it be done laparoscopically?”

Heller myotomy and partial fundoplication surgery is commonly performed for achalasia. During a Heller myotomy, your surgeon cuts open the muscle fibers of the lower esophageal sphincter to facilitate swallowing. The myotomy, (cutting muscle fiber) is typically extended into the proximal stomach where gastric pouch for gastric bypass surgery is constructed.

Your bariatric surgeon needs to first undo the partial fundoplication. Then, the bariatric surgeon constructs a gastric pouch away from the myotomy was performed to minimize staple line leak. Conversion of Heller myotomy to gastric bypass is typically done through tiny incisions or laparoscopically.

A second option is to convert a Heller myotomy and partial fundoplication to gastric sleeve surgery. This approach is feasible, but not recommended due to increased acid reflux after fundoplication take down.

A third option is to keep the fundoplication intact and construct a gastric pouch below the wrap. This approach is particularly used when dense adhesions are encountered between the wrap and posterior esophagus.

In summary, weight loss surgery is feasible after Heller myotomy. Extra care must be taken to prevent staple line leak. Overall, the surgery is safe and easily performed through tiny incisions.

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