Heller Myotomy

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General Surgery
Related Conditions

Achalasia Barrett's Esophagus Esophageal Cancer Gastroesophageal Reflux Disease (GERD)

Related Physicians

Section Faculty Jonathan Carter, M.D. Stanley J. Rogers, M.D.

The Heller myotomy is a laparoscopic (minimally invasive) surgical procedure used to treat achalasia. Achalasia is a disorder of the esophagus that makes it hard for foods and liquids to pass into the stomach. The Heller myotomy is essentially an esophagomyotomy, the cutting the esophageal sphincter muscle, performed laparoscopically. The operation's success rate is very high and usually permanent. A small number of patients may need addtional treatment.

Description of Procedure

In the procedure, several tiny incisions are made and a small scope inserted, through which miniature surgical instruments are passed. The scope is connected to a video camera which then sends a magnified image to a monitor, allowing the surgeon to envsion the anatomy and manipulate the instruments.. The advantages of the Heller myotomy include: Less post-operative pain A 1-2 day hospital stay vs. up to a week with a conventioonal open procedure Faster recovery from surgery A more rapid return to work and normal activities

Nissen Fundoplication
Many patients develop gastroesophageal reflux disease (GERD) after a Heller myotomy. To avoid the development of the condition where contents of the stomach reflux (back up) into the esophagus, a Nissen fundoplication is may be performed at the same time the esophageal sphincter muscle is cut. This procedure, alsoperformed laparoscopically, involves wrapping the upper part of the stomach around the lower esophegeal sphincter to strengthen it.

A Cushing ulcer is a gastric ulcer produced by elevated intracranial pressure. It is also called von Rokitansky-Cushing syndrome. Apart from in thestomach, it may also develop in the proximal part of the duodenum and the distal esophagus. It is named for Harvey Cushing.
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Causes[edit]
One possible explanation for the development of Cushing ulcers is the stimulation of vagal nuclei due to the increased intracranial pressure which leads to increased secretion of gastric acid. Thevagus nerve releases acetylcholine, which stimulates the M3 receptor on the parietal cell and activates the second messenger to stimulate IP3/Ca2+ to stimulate the Hydrogen/Potassium ATPase pump which will increase gastric acid production. It may also be a direct result of Cushing reaction.

Curling's ulcer or a Curling ulcer is an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasmavolume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The condition was first described in 1823 and named for a doctor,Thomas Blizard [1] Curling, who observed ten such patients in 1842. It is also known an GI ulceration. These stress [1] ulcers were once a common complication of serious burns, presenting in over 10% of cases, and

especially common in child burn victims. They result in perforation andhemorrhage more often than [3] [1] other forms of intestinal ulceration and had correspondingly high mortality rates. A similar condition involving elevated intracranial pressure is known as Cushing's ulcer.

[2]

Treatment[edit]
While emergency surgery was once the only treatment, combination therapies including enteral feeding with powerful antacids such as H2-receptor antagonists or, more recently, proton pump [4] inhibitors such as omeprazole have made Curling's ulcer a rare complication.

Kehrov znak je pojava akutne boli u vrhu ramena zbog prisutnosti krvi ili drugih iritansa u peritonealnoj upljini kad osoba lei i noge su podignute. Kehrov znak se smatra klasinim simptomom rupture slezene, no moe biti rezultat i dijafragmatske ili peridijafragmatske lezije, renalnih kamenaca, ozljede slezene ili rupture ektopine trudnoe. Kehrov znak je klasini primjer referirane (prenesene) boli: osjeaj nadraivanja dijafragme prenosi frenini ivac (nervus phrenicus) kao bol u podruju iznad kljune kosti. To se dogaa zato to supraklavikularni ivci (nervi supraclaviculares) imaju isto porijeklo kao frenini ivac, tj. iz C3 i C4 ansae cervicalis, tj. vratnih spinalnih ivaca.