Re: Questions about surgery.

[Guest guest]

Hi Jess,

> Is there a difference between a Heller and a Myotomy?

Someone posted that the word " myotomy " means " to cut. " I think

Heller is the person that " invented " this particular surgery.

> I know there are laparoscopic and another way. What do those terms

> mean, how are they done?

The laparoscopic meathod is done through 5 small incisions (the

largest being about 3/4 " ). Not everyone is a candidate for

laparoscopic method though. In this case, the Dr. must access the

area by means of a large traditional incision. Also, if anything

goes wrong during a laparoscopic surgery (ie. punctured spleen,

ruptured esophagus etc) then the Dr. must do an emergency incision.

> Is there a way to do this without an external incision (orally)?

I wish! When I went for my first sugical consult I was shocked that

they couldn't do it orally. No.

> Does anyone know the chance of infection in the incision, say from

> food?

I am unaware and don't know an answer.

> How long is the pre-op fast, or is there one?

The first Dr. I consulted said 3 days....but Dr. Rice at CC I believe

calls for a 48 hour fast of liquids only. I don't have my pre-op

paperwork yet so this is just what I have been reading.

> I keep hearing from people that their dilations failed. (Thus they

> needed surgery) What does that mean?

I was wondering this myself. If the sphictor is cut...then it's

cut. Why would it need a repeat surgery?

-Jess

> How many people here have had surgery without ever having another

> procedure done first? Is there a specific reason for that?

Dr. Rice said that each previous proceedure can cause scarring that

can diminish the outcome of the Heller.

Joy (in Michigan)

[Guest guest]

Jess,

My surgeon, Horacio Asbun, is in Concord/Pleasant Hill, CA. He is the

director of advanced laparoscopic surgery at Mt. Diablo Medical Center

and is a master laparoscopic surgeon. He has the Da Vinci robot

available for his use in performing his myotomies giving him much more

accuracy and precision.

Sandi

Questions about surgery.

Questions about surgery.

I have been reading but I'm having trouble answering some of my

questions.

Is there a difference between a Heller and a Myotomy?

I know there are laparoscopic and another way. What do those terms

mean, how are they done?

Is there a way to do this without an external incision (orally)?

Does anyone know the chance of infection in the incision, say from

food?

How long is the pre-op fast, or is there one?

I keep hearing from people that their dilations failed. (Thus they

needed surgery) What does that mean?

-Jess

How many people here have had surgery without ever having another

procedure done first? Is there a specific reason for that?

I see no reference to central valley, Sacramento CA area surgeons in

the surgeon list. Does anyone have any advice on surgeon's in my area?

I'm with UC for Pete's sake, you'd think they would have a

specialist if anyone would. They have the Shriners hospital too after

all.

I'm sure I've got more questions, but these are the ones I really want

a handle on before I even see a GI. Thanx to everyone who reply's, you

all are a wealth of knowledge.

[Guest guest]

HI

I had the 'traditional' myotomy, not Heller's Myotomy. That means I was cut

open between the ribs and not laproscopically. I guess the myotomy itself

means the type of the operation, that the muscles are cut in the esophagus,

a small part of the top layer is taken off and seperated from the nerves.

I never had the dialation made before the operation, but I had botox

injections twice.

Siiri Sirke

>From: " Joy " <q.t@...>

>Reply-achalasia

>achalasia

>Subject: Re: Questions about surgery.

>Date: Fri, 27 Aug 2004 12:37:16 -0000

>

>Hi Jess,

>

> > Is there a difference between a Heller and a Myotomy?

>Someone posted that the word " myotomy " means " to cut. " I think

>Heller is the person that " invented " this particular surgery.

>

> > I know there are laparoscopic and another way. What do those terms

> > mean, how are they done?

>The laparoscopic meathod is done through 5 small incisions (the

>largest being about 3/4 " ). Not everyone is a candidate for

>laparoscopic method though. In this case, the Dr. must access the

>area by means of a large traditional incision. Also, if anything

>goes wrong during a laparoscopic surgery (ie. punctured spleen,

>ruptured esophagus etc) then the Dr. must do an emergency incision.

>

> > Is there a way to do this without an external incision (orally)?

>I wish! When I went for my first sugical consult I was shocked that

>they couldn't do it orally. No.

>

> > Does anyone know the chance of infection in the incision, say from

> > food?

>I am unaware and don't know an answer.

>

> > How long is the pre-op fast, or is there one?

>The first Dr. I consulted said 3 days....but Dr. Rice at CC I believe

>calls for a 48 hour fast of liquids only. I don't have my pre-op

>paperwork yet so this is just what I have been reading.

>

> > I keep hearing from people that their dilations failed. (Thus they

> > needed surgery) What does that mean?

>I was wondering this myself. If the sphictor is cut...then it's

>cut. Why would it need a repeat surgery?

> -Jess

> > How many people here have had surgery without ever having another

> > procedure done first? Is there a specific reason for that?

>Dr. Rice said that each previous proceedure can cause scarring that

>can diminish the outcome of the Heller.

>

>Joy (in Michigan)

>

>

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[Guest guest]

Hi Jade,

Regarding your questions:

A Heller myotomy is named after a Dr Heller who first did the procedure. 'Otomy' means to cut or make a hole and 'my' refers to a muscle = to cut a muscle. The Lower Oesophageal Sphincter (LES) is the muscle that closes off the oesophagus from the stomach. In achalasia this muscle goes into spasm permanently or does not work properly. To release the spasm the surgeon cuts the muscle across its width (like cutting a piece of string) and also cuts up into the wall of the oesophagus and down into the wall of the stomach. If this is not done as well, the op is often not successful. They do not cut the inner mucous membrane. This is where perforation can happen, and why many surgeons will not let you eat solid food for a week or more.

Laparoscopic means that the operation is done using a laparoscope - a specialized instrument like along flexible tube which has a camera and instruments fitted to its end.

Thoracic means 'chest' - they go in to do the surgery via the chest cavity. Laperotomy - opening in the stomach wall.- the traditional abdominal surgery which is still used if the surgeon needs to see clearly what is happening and where he is going. Sorry- they can't go in through the mouth because they need to be cutting the outer muscle.

Most Surgeons ask for a fasting period before surgery, but some also take the precaution of washing out the oesophagus before they start surgery. Usually food should not get to the site of surgery, but if there is a perforation then there could be a problem. Infection in the incision is not common.

A dilatation is done to open the LES. When it is done correctly the LES muscle is not just stretched but actually torn. So you are doing much the same as surgery, but not as efficiently or effectively. When this fails the person is no better then before.

When a dilation is done and the LES muscle is torn scar tissue will form and this may make difficulties for the surgeon who tries to cut it. Botox also causes problems for the surgeon. That is the main reason why they prefer to do the surgery first.

Hope this explains things !

Joan

Questions about surgery.

Questions about surgery.I have been reading but I'm having trouble answering some of my questions.Is there a difference between a Heller and a Myotomy?I know there are laparoscopic and another way. What do those terms mean, how are they done?Is there a way to do this without an external incision (orally)?Does anyone know the chance of infection in the incision, say from food?How long is the pre-op fast, or is there one?I keep hearing from people that their dilations failed. (Thus they needed surgery) What does that mean?-JessHow many people here have had surgery without ever having another procedure done first? Is there a specific reason for that?I see no reference to central valley, Sacramento CA area surgeons in the surgeon list. Does anyone have any advice on surgeon's in my area? I'm with UC for Pete's sake, you'd think they would have a specialist if anyone would. They have the Shriners hospital too after all.I'm sure I've got more questions, but these are the ones I really want a handle on before I even see a GI. Thanx to everyone who reply's, you all are a wealth of knowledge.

[Guest guest]

Now that's not too bad, 1 1/2 to 2 hr drive from here. Thank you, I'll

keep him in mind.

> Jess,

> My surgeon, Horacio Asbun, is in Concord/Pleasant Hill, CA. He is

the

> director of advanced laparoscopic surgery at Mt. Diablo Medical

Center

> and is a master laparoscopic surgeon. He has the Da Vinci robot

> available for his use in performing his myotomies giving him much

more

> accuracy and precision.

>

> Sandi

>

>

> Questions about surgery.

>

> Questions about surgery.

>

> I have been reading but I'm having trouble answering some of my

> questions.

>

> Is there a difference between a Heller and a Myotomy?

>

> I know there are laparoscopic and another way. What do those terms

> mean, how are they done?

>

> Is there a way to do this without an external incision (orally)?

>

> Does anyone know the chance of infection in the incision, say from

> food?

>

> How long is the pre-op fast, or is there one?

>

> I keep hearing from people that their dilations failed. (Thus they

> needed surgery) What does that mean?

>

> -Jess

> How many people here have had surgery without ever having another

> procedure done first? Is there a specific reason for that?

>

> I see no reference to central valley, Sacramento CA area surgeons in

> the surgeon list. Does anyone have any advice on surgeon's in my

area?

> I'm with UC for Pete's sake, you'd think they would have a

> specialist if anyone would. They have the Shriners hospital too

after

> all.

>

> I'm sure I've got more questions, but these are the ones I really

want

> a handle on before I even see a GI. Thanx to everyone who reply's,

you

> all are a wealth of knowledge.

>

>

>

>

>

>

>