Achalasia – The Hellers Myotomy Operation

On Thursday, 23rd February 2017 I finally had my Hellers Cardiomyotomy and Nissen Fundoplication operation. It was performed laparoscopically by Mr T John, Consultant Surgeon, and his team at the Basingstoke & North Hampshire Hospital. Now that I’m starting the recovery I’m feeling more able to write about the lead up to the operation and the operation itself.

 

The road to the operation was a little fraught. At the start of January 2017 there had been some discussion between my consultants about whether the atrial fibrillation, that I had been diagnosed with back  in December 2016, should be treated first. However, it was finally decided that as I was probably no longer able to swallow the heart medication effectively, that they shouldn’t delay the operation any further. I was then quickly scheduled for my pre-operative assessment on Monday 13th February.

Pre-operative Assessment

I arrived in good time for the pre-operative assessment which was scheduled to start at 8.30am and would probably last a maximum of 3 hours. All the paperwork and tests, i.e. ECG, blood pressure and blood test, were completed in the first 90 minutes. However, I had to wait a bit longer while a doctor got hold of the right people, e.g. cardiologists, haematologists etc, to help her set up the strategy for bridging my anti-coagulation for the period of a week prior to the operation and a week after the operation. This took a bit longer than I’m imagined as she had difficulties getting access to the right people. The NHS is clearly running at full tilt!

I had been on Dabagitran for anti-coagulation since the previous December as part of the treatment for atrial fibrillation and my previous mini stroke. The surgeon had already informed me that Dabagitran was a novel anti-coagulant and there were concerns about the risks of ‘perioperative’ bleeding with this sort of novel agent. He, therefore, wanted me to come off it and be put on Enoxaparin instead. This entailed me taking a letter to my the GP the next day and getting a prescription for pre-filled syringes with which to inject myself with the required dose each day up to the operation.

I was also advised to maintain a purely liquid diet for the last 3 days prior to the operation so that as little food residue as possible  would be left in my oesophagus by the time of the operation.

At 4.30pm, 8 hours after I’d arrived,  I finally left Basingstoke Hospital satisfied that Mr John’s team knew everything they needed to know about me to minimise the risk of my pre-existing health conditions affecting the outcome of the surgery 10 days later.

Pre-Operation Diet

In the days between the pre-operative assessment and the operation itself, I tried to eat as well as I could and try to maintain my weight. However, the achalasia was not getting any better. Instead of keeping my weight stable I actually lost another 2 Kg (~4.5 lbs), and reached a new low of 77 Kg. That means that I had lost 13 Kg (~29 lbs) since my diagnosis in October.

Prior to the final 3 days, I would typically eat the following:

  • Breakfast – Porridge
  • Lunch – Beef lasagne or mashed potato with grilled cheese on top
  • Dinner – Soup with humous and pork liver pate

I would wash all meals down with at least a pint of water. In between meals I drink more water as well as cups of tea and the occasional fresh coffee.

In the final 3 days I transitioned to a liquid diet comprising of milkshakes using Complan and milk-based smoothies using whey protein, bananas and almond butter. While I was still taking peptac liquid, things were OK. However, on the morning of the operation I wasn’t able to take any peptac and any sips of water were initiating the regurgitation of residue from the milkshakes and smoothies. It was very clear that I was no longer able to swallow much apart from water! Bring on the operation – I’m ready.

Operation Day

I arrived at the hospital on operation day at my allotted time of midday. As directed I had not had any food to eat since 7am and had only sipped water after that. In fact I had only had a glass of milk to drink in the morning. As I wasn’t taking any peptac liquid, to calm things down in my oesophagus, I had had trouble swallowing that! I spent the morning bringing up stuff that was still in my oesophagus. By the time we left home, I had nothing further to bring up.

I was checked in by a nurse and later met the anaesthetist for my operation. Even though Mr John wasn’t scheduled to see me before the operation, I asked if I could see him. I was  glad I did as it put my mind, and my wife’s mind, at rest about the risks of surgery. What with the atrial fibrillation and the fact I’d had a mini stroke in August 2015, I was concerned about the risk of another stroke. He reassured that he would take good care of me and if everything went to plan I would be going home the following day – wow!

At about 1.30pm I was escorted by a scrub nurse to the operating theatre. This was about a 5 minute walk from the admissions lounge. Once inside the operating suite I was met by the anaesthetist and prepared for the operation. Apparently my right arm was going to be laid out at right angles to my body during the operation. I have no idea why! Soon after I was asked to take a few deep breaths of oxygen while the anaesthetic took effect.

Starting to Swallow Again

The next thing I knew I was waking up on the ward at around 7.45pm. Initially I was very groggy, but as I came to I soon realised that my wife was there and my operation had been done. It felt so good to have come out the other side!

A bit later my youngest daughter arrived to see me, along with her boyfriend. It’s at these times you realise the stress you have been putting your nearest and dearest through by being ill. They were probably just as worried as I was about this operation, but so relieved it was now over and we could look forward to me being able to eat things again and my life not being controlled by achalasia.

Later that evening I was encouraged to get out of bed and take myself to the bathroom. I was lucky to have an ensuite room to myself so I didn’t have to walk very far. However, getting out of bed was tricky. The 5 laparoscopic incisions in my stomach muscles meant that everything had to be done very slowly. I soon learnt that not twisting or flexing my core was the secret and to make sure I used my arm and leg muscles to do all the work when getting up and down from the bed.

Once settled back into bed I was given some codeine and paracetamol and a glass of water. To my amazement I swallowed them and didn’t see them again! Clearly my operation had been a success. I went to sleep very happy.

 

One Reply to “Achalasia – The Hellers Myotomy Operation”

Leave a Reply

Your email address will not be published.