What is the typical approach for performing a Heller myotomy?

• A. Laparoscopic.
• B. Open thoracotomy.
• C. Endoscopic clipping.
• D. Robot-assisted esophagectomy.

Answer: (A)

The typical approach is laparoscopic. This minimally invasive route gives excellent visualization of the distal esophagus and the gastroesophageal junction, allowing precise division of the circular muscle fibers of the lower esophageal sphincter while preserving the mucosa. It also enables a concurrent partial fundoplication to reduce reflux after the myotomy, which is commonly performed to prevent new reflux symptoms once the LES is released. Compared with open thoracotomy, the laparoscopic approach results in less pain, shorter recovery, and fewer complications. Endoscopic clipping won’t cut the sphincter muscle, and robot-assisted esophagectomy is far more extensive than needed for this procedure. An alternative endoscopic option exists (POEM), but the traditional and most common method remains laparoscopic Heller myotomy.