10 Andover Road
Laparoscopic
Heller Myotomy
Post-Operative Instructions
Description of the Operation
I will be doing a laparoscopic Heller-Dor or laparoscopic Heller-Toupet
procedure
for you. The Heller myotomy involves dividing the sphincter muscle at the lower end of your
esophagus. The sphincter doesn't relax normally right now and is responsible for a large
part of your swallowing trouble. Because this muscle is supposed to prevent
stomach acid from backing up into your esophagus, cutting it increases your
chance of having acid reflux (GERD) after surgery. For that reason I will also
perform either a
Dor fundoplication or, less frequently, a Toupet fundoplication.
These are methods of wrapping the stomach around the lower esophagus to lessen the
chance of GERD developing. I'll close your skin with tiny
pieces of tape or transparent glue. Be prepared to spend one night in the hospital,
although you might
not need to, depending upon how you feel after surgery.
Your Recovery
Because your operation will be done laparoscopically, I'll put little or no
restrictions on your physical activity after a Heller-Dor operation. Your level of
discomfort should prevent you from over-exerting yourself. As long as you don't
lift or strain beyond the point where it hurts, you should be fine. If you
instead have a Heller-Toupet, vigorous straining (or prolonged vomiting)
too soon after surgery can damage your diaphragm muscle before the stitches in
it have had a chance to heal. This can cause your stomach to move out of
position (a hiatal hernia) and the operation to fail or even require
re-operation. After a Heller-Toupet, you
should avoid heavy-lifting and any activity that causes you to strain and
"get red in the face" for at least a month to let the diaphragm heal.
If you're unsure which operation you had, call the office or simply take it easy
for a month. You should be able to return to work or usual activities within a few days to a few weeks, depending on the activities. You
may resume showering the day after surgery. Simply let the pieces of tape or
spots of glue fall
off on their own.
Pain Relief
1. Take Extra Strength Tylenol (or generic acetaminophen) 1000mg every 6 hours
for 3 days, then only as needed to control discomfort.
2. Take Advil (or generic ibuprofen) 600mg every 6 hours for 3 days, then only
as needed to control discomfort. [DO NOT use Advil if you have a history of
stomach or intestinal ulcers or have had problems taking aspirin in the past.]
3. Take 1-2 oxycodone 5mg tablets every 3 hours as needed for discomfort that
remains after taking Tylenol & Advil. Not everybody needs this, so you might
choose not to fill the prescription. This is a narcotic pain killer. If you use
it you must beware of becoming drowsy or inattentive, and you will not be able
to drive or operate dangerous equipment. It can also cause nausea and
constipation.
The above combination is for maximum pain control. You may skip some or all of the medications if you're comfortable without them.
Other Medications
1. Discontinue taking any anti-acid medications (Prilosec, Prevacid, Aciphex,
Protonix, Pepcid,
Zantac, Axid, Tagamet) after surgery unless I instruct you otherwise.
2. Resume your other usual medications unless I instruct you otherwise.
Most Frequent Problems
Discomfort
- Abdominal soreness and a dull shoulder & neck ache are the most common
immediate problems after waking up. The shoulder ache usually lasts a day or two
but some soreness under the ribs commonly lasts for a
couple of weeks.
Trouble swallowing
- You should notice immediate improvement in your swallowing. You may still
have some difficulty swallowing solid foods initially and possibly always. You
will go home on a liquid diet and can advance it on your own. Most people should
resume eating as though nothing has changed and gradually increase what they eat
as they gain confidence that swallowing actually is better. Sometimes I ask a
person to stay on a liquid diet for a week before advancing to solid food, but
I'll make it very clear if that's to be the plan for you. Always eat in an
upright position because you need gravity to carry the food into your stomach
since your esophagus doesn't have the squeezing motion of an esophagus that
isn't affected by achalasia. If it requires teeth to eat, start with small
bites, chew thoroughly and eat slowly. Don't get discouraged if some bites feel
as though they still stick in your chest. There is some swelling at the site of
surgery that should resolve over a couple of months, further improving your
swallowing.
Nausea
- If you feel okay when you leave the hospital but start to feel nauseated at
home, it is probably caused by the prescription pain killer. You might want to
take only the Tylenol and Advil in that case or call me for a different
prescription (which might also causes nausea). Prolonged vomiting or dry
heaves soon after surgery puts more stress on the operation than I'd like.
Reasons to Call Me
1. Pain not controlled by your medication
2. Persistent vomiting or dry heaves
3. Fever and wound redness or persistent leakage from an incision
4. Any questions or concerns what-so-ever
Pre-Operative Appointment (if required)
Location: Date: Time:
Surgery Appointment
* Please start on a liquid diet two days before surgery so your esophagus won't
still have solid food in it during the operation. Don't eat or drink anything at
all after midnight before surgery (except to take your usual medications).
Location: Date:
Arrival Time: Surgery Time:
Post-Operative Office Appointment
Date: Time:
I would like to see you in 3-4 weeks. Please call to confirm your
appointment or to arrange one if you don't have a date & time yet. If you
don't live near Portland and would like a telephone call instead of an office
visit just let us know a few days before your appointment.
Last updated 4/7/07