Primary Cardiomyotomy Surgery

​​

Definition

​

• Elective surgery to correct symptoms of a diagnosis of Achalasia which may or may not have previously been treated with botox or pneumatic dilation

​

• Achalasia surgery is very low-volume, however fundamentals of investigation, diagnosis and surgical technique have significant ‘cross-over’ with other hiatal procedures. We recommend patient management of this condition in those units that fulfil hiatal surgery service recommendations​

​

​​

​

Investigations

​

• As a minimum, OGD/Contrast swallow should be performed along with high-resolution manometry

​​​

​​

​

​

Management 

​

• All patients should be discussed at hiatal MDT prior to surgery to achieve consensus diagnosis of achalasia

​

• All patients should have had discussion about botox injection/pneumatic dilatation and be made aware POEM is an alternative treatment option although at present limited availability

​

• Enter data into a registry to audit outcomes​​

​

• Adequate myotomy is defined as at least  >5cm on oesophagus and >2cm on stomach (below GOJ)

​​​​​

• Although there is some evidence of increased risk of SCC with achalasia no specific recommendation for routine follow up surveillance OGDs

​

• Recurrent achalasia should be managed by a high-volume hiatal unit within a region that has experience of pneumatic dilation and POEM

​

• Hiatal MDT Core Representation: ≥2 Surgeons/Gastroenterologist/Radiologist/Clinical Scientist or equivalent (healthcare professional running pH/manometry service) and Specialist Nurse

​

 

​

Key Performance Indicators 

​

​

• Readmission rates within 30 days <10%

​

• Laparoscopic conversion to open < 5%

​

• Less than 24 hour stay for Laparoscopic Cardiomyotomy > 90%

​

• Morbidity <5%

​

• Mortality < 0.1%

​​​