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Laparoscopic Heller myotomy for achalasia
Condition Guide

Achalasia
Laparoscopic Heller myotomy — the gold-standard surgical treatment

Achalasia is a rare swallowing disorder. The ring of muscle where your esophagus meets your stomach won’t relax the way it should, and the esophagus loses its normal squeezing motion. Food and drink collect in the esophagus instead of passing into the stomach — so swallowing slowly becomes harder over time. The good news: a keyhole operation can fix the mechanical problem and let you eat and drink comfortably again.

Heller myotomy
Procedure
1–2 nights
Hospital stay
Keyhole
Minimally invasive
~4 weeks
Full recovery

What is achalasia?

Your esophagus is the tube that carries food from your throat to your stomach. At the bottom is a valve (the lower esophageal sphincter) that opens to let food through, then closes. In achalasia, this valve stays tight and the esophagus stops pushing food downward. The result is food and liquid backing up instead of going down. It’s not caused by anything you did, and it isn’t cancer — but it does need treatment to manage.

Signs & symptoms

  • Trouble swallowing — both solid food and liquids feel stuck
  • Bringing food back up (regurgitation), especially when lying down
  • Chest pain or pressure after eating
  • Heartburn-like burning that doesn’t respond to usual reflux medicine
  • Slow, unplanned weight loss
  • Coughing or choking at night

How it’s diagnosed

  • High-resolution manometry — a thin tube measures the muscle pressure in your esophagus. This confirms the diagnosis and its type.
  • Barium swallow — you drink a chalky liquid and an X-ray shows the classic narrowed “bird-beak” shape.
  • Upper endoscopy — a small camera looks inside to rule out other causes.

Treatment options

  • Heller myotomy — keyhole surgery to release the tight valve. The most durable, long-lasting fix.
  • Balloon dilation — stretching the valve open; may need to be repeated.
  • Botox injection — relaxes the valve temporarily; useful for some patients.
  • POEM — a newer scope-based technique done through the mouth.
Patient tool
Measure your achalasia symptoms

Take the Eckardt score — the standard 4-question scale doctors use worldwide — and see how controlled your symptoms are, with feedback you can share with your doctor.

Open tool →
Dr. Irshad’s approach

Laparoscopic Heller myotomy

Through a few small keyhole cuts in the abdomen, Dr. Irshad carefully divides the tight muscle fibres of the lower esophageal valve so food and liquid can pass freely again. To stop acid from washing back up afterward, this is usually paired with a partial wrap (fundoplication) using part of your own stomach.

Because it’s done with keyhole techniques, most patients have less pain, only a one- to two-night hospital stay, and a quick return to everyday life. For most people the improvement in swallowing is dramatic — many describe eating a normal meal for the first time in years.

Your recovery, step by step

Hospital

1–2 nights. Most patients go home the day after surgery.

Weeks 1–2

Soft diet — soups, yoghurt, mashed foods. Avoid bread and tough meats while things heal.

Weeks 3–4

Gradual return to a regular diet. Many notice a big improvement in swallowing.

4 weeks

Follow-up visit and full return to normal activity.

Download recovery guide (PDF)A printable guide to take home.

Common questions

Are there different types of achalasia?
Yes. The manometry test sorts achalasia into three types based on how the esophagus behaves. Type I — the esophagus has little or no squeezing motion. Type II — pressure builds up along the whole esophagus (this type tends to respond best to treatment). Type III — there are strong, uncoordinated spasms. Knowing your type helps Dr. Irshad recommend the right treatment and plan how much muscle to release during surgery.
Will I have heartburn or reflux after surgery?
Releasing the tight valve can let stomach acid wash back up, so Dr. Irshad usually adds a partial wrap (a Dor or Toupet fundoplication) at the same time, using part of your own stomach as a new one-way valve. This greatly reduces reflux while still letting food pass easily. If any heartburn does occur, it can usually be managed with medication.
How does POEM compare to Heller myotomy?
POEM is a newer technique done with a scope through the mouth, with results similar to Heller myotomy. Its main trade-off is a higher chance of acid reflux afterward. Dr. Irshad will talk through which approach fits your situation best.
Will my swallowing be completely normal after surgery?
Most patients improve dramatically — many describe it as life-changing, eating and drinking normally for the first time in years. A little slowness can remain at first, and this usually keeps improving over the following months.
What tests will I need before surgery?
Usually a high-resolution manometry to confirm the diagnosis and its type, a barium swallow, and often an upper endoscopy to rule out other causes. Dr. Irshad’s office arranges these for you.
Is achalasia curable?
There’s no way to restore the nerves that control the esophagus, but surgery very effectively treats the mechanical problem. Most patients get long-lasting relief and a return to normal eating.

Preparing for your surgery at William Osler

Your operation takes place at William Osler Health System (Brampton Civic Hospital). These are the hospital’s general instructions for getting ready, the day itself, and afterwards — always follow any specific advice Dr. Irshad gives you. Full details are on the Osler Surgical Services page.

Before your surgery
  • Do not eat anything (including gum) after midnight the night before. Unless told otherwise, you may have clear fluids — water, pulp-free juice, black coffee or tea — up to 2 hours before.
  • No alcohol, smoking, or marijuana for 24 hours before surgery.
  • Shower the evening before and the morning of surgery (with chlorhexidine soap if you have it). Skip lotion, perfume, makeup and nail polish.
  • Bring your OHIP card and photo ID, all your medications in their original containers (inhalers, insulin, supplements), and your CPAP machine if you use one.
  • Arrange a responsible adult to drive you home — a taxi, Uber or Lyft does not count, and surgery may be cancelled without one.
  • Leave jewellery, money and valuables at home.
The day of your surgery
Arrive about 2 hours before your scheduled time. Register at the central registration desk in the main lobby at Brampton Civic Hospital (2100 Bovaird Drive East), then go to the Day Surgery area. Staff will help you change, check your vitals, confirm the details from your pre-anaesthesia visit, and start an IV before you go to the operating room. Your family member can wait in the surgery waiting area.
After your surgery
You’ll wake up in the Post-Anaesthesia Care Unit, then move to Day Surgery or an inpatient room (or the Intensive Care Unit if you need closer monitoring). For the first 24 hours after the anaesthetic, have an adult with you, do not drive or operate machinery, avoid alcohol, and hold off on big decisions. A follow-up appointment is booked before you leave. Learn more about discharge and pain management.
The pre-anaesthesia clinic
Before your operation you’ll get a call from the pre-anaesthesia clinic for an education call or an in-person visit, where the team reviews your health, your medications and your anaesthetic plan.

Medically reviewed by Dr. Kashif Irshad, MD, MSc, FRCSC · Last updated July 2026

A referral from your family doctor or specialist is all that’s needed to be seen by Dr. Irshad. Find the referral forms and clinic details below.

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