Laparoscopic cardiomyotomy
Preparation:
As for general anaesthesia
Procedure:
The procedure is generally performed using 5 small incisions in the abdominal wall to allow a camera and instruments to be inserted. The muscle at the junction between the gullet (oesophagus) and stomach is divided and extended for approximately 10cm into the oesophagus. This incision is deepened through the full thickness of the muscle but does not breach the inner most (mucosal) layer of the oesophagus. This is known as a cardiomyotomy and is frequently combined with an anti-reflux procedure [see laparoscopic fundoplication] as there is a high risk of gastro-oesophageal reflux after such surgery.
Anaesthetic:
General
Post Operative Care:
Patients can start eating after recovery from anaesthesia. As with many intra-abdominal laparoscopic procedures shoulder tip pain may be a problem over the initial post-operative period. Patients are generally mobile within the first 24 hours but it is likely to be 2 weeks before there is 100% return to daily activities. Normally patients would expect to stay in hospital until seen to be taking a full diet.
The complications of the procedure include perforation of the full thickeness of the oesophagus. This is generally recognised at the time of the operation and is readily stitched and unlikely to lead to significant problems.
If a cardiomyotomy is performed without a fundoplication there is a high risk of gastr-oesphageal reflux post operatively, however if combined with a fundoplication patients run the risk of the complications of bloating and difficulty swallowing as discussed above [laparoscopic fundoplication]. Your surgeon will discuss the advantages and disadvantages with you prior to any surgery.
OPC Codes: G0920
