Heller's myotomy (achalasia surgery)

A keyhole operation for achalasia that cuts the tight muscle at the lower end of the gullet so food and drink can pass into the stomach more easily, usually with a partial wrap to limit acid reflux.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

Heller's myotomy cuts the tight lower gullet muscle so food can pass into the stomach more easily — it relieves the blockage but does not cure achalasia or restore normal swallowing.
A partial wrap is usually added at the same time to reduce acid reflux, which is a common side effect of cutting the muscle.
It works well for most people and tends to be durable, but some swallowing difficulty can remain or return over the years, and reflux can develop.
Achalasia is best managed in a specialist centre, where the choice between myotomy, balloon stretching and POEM can be discussed.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeKeyhole surgical procedure for achalasia

AnaestheticGeneral anaesthetic

How long it takesOften around 1.5–3 hours

Hospital stayOften one to a few nights

Time off workCommonly around 2–4 weeks, depending on the job

When you'll see resultsSwallowing often improves soon, on a staged diet; full settling over the first weeks

On the NHS?Available on the NHS for achalasia, usually in specialist upper GI centres

A general guide. Your surgeon will give you advice for your situation.

Best fit

Often relieves difficulty swallowing and regurgitation

Pause if

Your swallowing difficulty is not due to achalasia, so cutting the muscle would not help — testing should confirm the diagnosis and type.

Main recovery point

Expect soreness around the cuts and possibly shoulder-tip pain from the gas. You start on liquids or soft food, sometimes after a check that there is no...

Good aftercare

Clear written diet advice for the staged return to normal food, with dietitian support if needed.

First 24–48 hours

Expect soreness around the cuts and possibly shoulder-tip pain from the gas. You start on liquids or soft food...

First 1–2 weeks

You follow a soft or liquid diet, taking small amounts slowly. Swallowing often improves quickly but can feel...

Weeks 2–4

You gradually return to more normal foods, chewing well and avoiding large mouthfuls. Avoid heavy lifting and...

Beyond 4 weeks

Most people are back to a normal diet and activities. Watch for new heartburn (a sign of reflux) or swallowing...

Medical line illustration of oesophageal manometry ph monitoring for Heller's myotomy (achalasia surgery). — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is Heller's myotomy (achalasia surgery)?

Achalasia is an uncommon condition where the muscle ring at the lower end of the gullet (oesophagus) does not relax properly and the gullet loses its normal squeezing movement. Food and drink struggle to pass into the stomach, causing difficulty swallowing, bringing food back up (regurgitation), chest discomfort and weight loss. It cannot be cured, but treatments aim to relieve the blockage so swallowing improves.

Heller's myotomy is an operation, usually done by keyhole, that cuts the tight muscle at the lower gullet and top of the stomach so this part can no longer squeeze shut. Because cutting the muscle can let stomach acid flow back up, the surgeon usually adds a partial wrap (a partial fundoplication, such as a Dor) at the same time to reduce reflux. It is one of the main treatments for achalasia, alongside stretching the muscle with a balloon (pneumatic dilatation) and a newer endoscopic operation called POEM (peroral endoscopic myotomy).

Heller's myotomy relieves the blockage well in most people and tends to give durable improvement, but it does not restore normal gullet movement, so some swallowing difficulty can remain or return over the years. It can also cause acid reflux, even with the added wrap. The right treatment depends on the type of achalasia, your age and health, and local expertise, so achalasia is best managed in a specialist centre.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Laparoscopic Heller's myotomy with partial fundoplication

The standard operation: by keyhole, the surgeon cuts the tight muscle and adds a partial wrap (such as a Dor or Toupet) to reduce reflux. This is the usual surgical treatment for achalasia.

Open Heller's myotomy

The same muscle-cutting operation through a larger cut in the tummy or chest. Used less often now, mainly where keyhole is not safe or possible.

Pneumatic (balloon) dilatation

Not surgery, but a main alternative: a balloon is passed through the mouth and inflated to stretch and tear the tight muscle. Often effective but may need repeating, and carries a small risk of tearing the gullet.

POEM (peroral endoscopic myotomy)

A newer keyhole-through-the-mouth operation that cuts the muscle from inside the gullet, with no tummy cuts. Very effective for swallowing and good for certain achalasia types, but tends to cause more acid reflux than Heller's myotomy as no wrap is added.

Botox injection

Not surgery: botulinum toxin is injected into the muscle to relax it. Effect is temporary and usually wears off, so it is mainly used for people not suited to other treatments.

Heller's myotomy vs POEM

Heller's myotomy	POEM
Keyhole through the tummy	Keyhole through the mouth
Anti-reflux wrap usually added	No wrap added
Good, durable swallowing relief	Good, sometimes greater swallowing relief
Less acid reflux afterwards	More acid reflux afterwards
Long track record	Newer, shorter-term evidence

Both relieve the blockage well. Heller's myotomy adds an anti-reflux wrap so causes less reflux; POEM avoids tummy cuts and may relieve swallowing more, but causes more reflux. The best choice depends on the achalasia type and local expertise.

Preparing for your surgery

Be assessed in a specialist upper GI centre, where tests confirm achalasia and its type and the treatment options are discussed.
Expect tests beforehand, often a gastroscopy, a pressure study of the gullet (manometry) and a swallow X-ray (barium swallow).
Discuss the realistic aim — relieving the blockage and improving swallowing, not curing achalasia — and the chance of reflux afterwards.
Tell the team about all medicines, especially blood thinners, and about other health problems.
Stop smoking as early as you can, as it raises the risk of chest, wound and healing problems.
Follow advice on diet before surgery; you may be asked to take only liquids for a period so the gullet is empty.
Plan for a staged soft or liquid diet for a period afterwards, and stock suitable foods at home.
Arrange time off work, help at home and a lift, as you should not drive for a period afterwards.

What happens

The operation is usually done by keyhole, under general anaesthetic, so you are asleep. The surgeon makes several small cuts and gently inflates the tummy with gas to see clearly. They carefully cut the tight muscle at the lower gullet and top of the stomach so it can no longer squeeze shut, while taking care not to make a hole through the lining.

To reduce acid reflux from cutting the muscle, the surgeon usually adds a partial wrap (a partial fundoplication). If keyhole surgery is not safe or possible, they may convert to open surgery. Sometimes a check is done during or soon after the operation to confirm there is no leak.

Most people stay in hospital for one to a few nights. You usually start on liquids and soft food and build up gradually over the following weeks. You will be given clear diet and activity advice before going home.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Your swallowing difficulty is not due to achalasia, so cutting the muscle would not help — testing should confirm the diagnosis and type.
A different achalasia treatment (such as POEM or balloon stretching) may suit your type of achalasia better.
You are not currently fit enough for a general anaesthetic until other health problems are managed.
There is concern about another condition, such as a tumour at the lower gullet, that needs excluding first.

Delay surgery if…

You have an active infection or are acutely unwell.
Your blood-thinning medicine cannot yet be safely managed around surgery.
The tests needed to confirm achalasia and its type (such as manometry) have not yet been done.
Your gullet has not been emptied as advised before surgery.
You are pregnant or there are other reasons surgery is better postponed.

Alternatives to discuss

Pneumatic (balloon) dilatation to stretch the tight muscle, which may need repeating.
POEM (peroral endoscopic myotomy), a newer endoscopic operation, in suitable centres.
Botox injection into the muscle, mainly for people not suited to other treatments, as its effect wears off.
Medicines to relax the muscle, which are generally less effective and used in limited situations.
The NHS specialist pathway rather than private care if speed is not the priority.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

You are fully asleep. This is standard for Heller's myotomy, whether keyhole or open.

Benefits

Often relieves difficulty swallowing and regurgitation
Tends to give durable improvement for many years
The added partial wrap reduces acid reflux compared with cutting the muscle alone
Can improve eating, weight and quality of life in suitable patients
Keyhole surgery usually means small scars and a relatively quick recovery

Risks & complications

More common

Difficulty swallowing in the early weeks, so a soft or liquid diet is needed at first
Some chest or upper tummy discomfort early on
Shoulder-tip pain from the gas used in keyhole surgery, which settles
Acid reflux or heartburn, which can occur even with the added wrap

Less common

Swallowing difficulty that persists or returns, sometimes needing balloon stretching or further treatment
Reflux that needs long-term acid-suppressing medicines
Wound infection or bleeding
Needing to convert from keyhole to open surgery

Rare but serious

A hole made in the gullet or stomach lining during surgery; if not recognised, a leak can be serious
Injury to the gullet, stomach, spleen or other nearby organs
Blood clots in the legs or lungs
Serious problems related to the general anaesthetic

The two main specific issues are acid reflux afterwards (which the partial wrap aims to reduce) and the chance that swallowing difficulty persists or returns, as the operation relieves the blockage but does not restore normal gullet movement. A rare but important risk is making a hole in the gullet lining, which is usually repaired during surgery but can be serious if missed. Ask your surgeon how many achalasia operations they do, how they reduce reflux, what they would do if a hole occurred, and how Heller's myotomy compares with POEM or balloon stretching for you.

Published figures to discuss

How well surgery relieves swallowing, and how often reflux or returning symptoms occur, depends on the type of achalasia, the surgeon's and centre's experience, and patient factors. Heller's myotomy and POEM relieve swallowing well in most people; POEM tends to cause more reflux because no anti-reflux wrap is added. The points below are cautious statements from the achalasia literature, not guarantees for any one person, and reported rates vary between studies.

Figure	Reported range	How to interpret it	Source / confidence
Successful relief of swallowing difficulty	Reported in around 90% or more in many series in the shorter term, with good durability over years	Success can fall over time as the underlying achalasia remains. Depends on achalasia type and centre experience.	POEM vs laparoscopic Heller myotomy and pneumatic dilation — systematic review (PMC)ncbi.nlm.nih.govPublished figure
Acid reflux after surgery	Occurs in a notable minority; systematic reviews generally find reflux lower after Heller myotomy with fundoplication than after POEM	May need long-term acid-suppressing medicines. The added partial wrap aims to reduce this.	Guide sourcesClinical context
Hole made in the gullet/stomach lining (mucosal perforation)	Uncommon, often reported in the low single figures in experienced series; usually recognised and repaired during surgery	Can be serious if not recognised. Rates depend on surgeon and centre experience.	POEM vs laparoscopic Heller myotomy and pneumatic dilation — systematic review (PMC)ncbi.nlm.nih.govSource-linked context
Returning swallowing difficulty needing further treatment	Around 10–20% have persistent or recurrent symptoms after Heller myotomy in some reports and may need further therapy	Because the underlying achalasia is not cured, symptoms can return. Ongoing follow-up is advised.	POEM vs laparoscopic Heller myotomy and pneumatic dilation — systematic review (PMC)ncbi.nlm.nih.govPublished figure

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from keyhole surgery is usually fairly quick in terms of pain and wounds, but the gullet needs time to settle. Most people follow a staged diet over several weeks while early swallowing difficulty improves.

First 24–48 hours

Expect soreness around the cuts and possibly shoulder-tip pain from the gas. You start on liquids or soft food, sometimes after a check that there is no leak. Most people are up and walking soon after surgery.

First 1–2 weeks

You follow a soft or liquid diet, taking small amounts slowly. Swallowing often improves quickly but can feel variable at first. Pain settles and many people with desk jobs return towards the end of this time.

Weeks 2–4

You gradually return to more normal foods, chewing well and avoiding large mouthfuls. Avoid heavy lifting and straining until your surgeon agrees.

Beyond 4 weeks

Most people are back to a normal diet and activities. Watch for new heartburn (a sign of reflux) or swallowing that worsens, and report these for review.

What's normal — and not a worry

Variable or tight swallowing in the first weeks, usually improving
Some chest or upper tummy discomfort early on
Needing smaller, softer meals at first
Shoulder-tip pain after keyhole surgery that settles within days
Some heartburn, which should be reported if it persists

Aftercare

Follow the staged diet advice, starting with liquids and soft food and building up gradually.
Eat small amounts slowly, chew well and avoid large mouthfuls early on.
Take pain relief as advised and reduce it as the pain settles.
Keep wounds clean and dry and follow advice on showering and dressings.
Walk a little and often to aid recovery and lower the risk of clots.
Avoid heavy lifting and straining for the period your surgeon advises.
Do not drive until you can perform an emergency stop comfortably and your insurer agrees.
Watch for warning signs such as chest pain, fever or being unable to swallow, and keep your follow-up appointments.

Before-surgery checklist

Soft and liquid foods stocked for the staged diet
Pain relief in stock and a plan for taking it
Loose, comfortable clothing
Help arranged for shopping, lifting and chores for a couple of weeks
Time off work booked (often around 2–4 weeks)
Someone to drive you home and stay for the first day
The clinic's contact number and a list of warning signs saved

Scars and how they heal

Keyhole surgery leaves several small scars on the tummy, usually including one near the navel, which fade over months to become discreet. If the operation is converted to open surgery, you will have one longer scar instead. Scars are pink and firm at first; sun protection helps them settle.

⚠ Get urgent help if…

Severe or worsening chest or tummy pain
A high temperature, shivering or feeling very unwell (possible infection or leak)
Being unable to swallow even liquids or your own saliva
Persistent vomiting, or vomiting blood
Spreading redness, heat, swelling or discharge from a wound
Breathlessness or fast breathing
A swollen, hot or painful calf, or breathlessness or chest pain (possible clot — call 999)

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means swallowing and regurgitation improve and you can eat a more normal diet, usually with durable benefit over many years, while the added partial wrap keeps reflux to a minimum. Many people regain lost weight and quality of life.

Heller's myotomy does not cure achalasia or restore normal gullet movement. Some swallowing difficulty can remain or return over time, and acid reflux can develop even with the wrap, sometimes needing long-term medicines or monitoring. Achalasia also slightly raises the long-term risk of gullet cancer, so ongoing follow-up matters. A good surgeon is honest that the aim is to relieve the blockage and improve symptoms rather than to cure the condition.

How long it lasts

Heller's myotomy tends to give durable relief of swallowing difficulty for many years in most people, which is one of its strengths. However, the underlying achalasia remains, the gullet still does not squeeze normally, and a proportion of people have swallowing difficulty that returns and may need balloon stretching or further treatment. Acid reflux can develop and may need ongoing medicines. Because achalasia carries a small long-term increase in gullet cancer risk, long-term follow-up, sometimes including periodic endoscopy, is usually advised.

Combining with other procedures

Heller's myotomy is routinely combined with a partial anti-reflux wrap in the same operation. It is not usually combined with unrelated procedures, and you should be cautious about add-on operations you did not come for. If swallowing difficulty later returns, a separate balloon stretching or, in some cases, POEM may be discussed.

Follow-up & long-term care

You will usually be reviewed after the operation to check your swallowing, diet and any reflux, and to discuss the tests done beforehand. Because achalasia is a long-term condition with a small cancer risk, ongoing follow-up, sometimes including periodic endoscopy, is usually advised. You should be told who to contact for chest pain, fever, swallowing problems or wound concerns.

Build back to a normal diet gradually, chewing well and eating slowly.
Report new or persistent heartburn, as reflux can develop and may need treatment.
Seek review if swallowing difficulty returns, as further treatment may help.
Attend long-term follow-up, including any recommended periodic endoscopy.
Stop smoking and limit alcohol, which also support gullet health.

Revision and secondary surgery reality

If swallowing difficulty returns, balloon stretching or, in some cases, POEM or further surgery may be considered.
Acid reflux after surgery may need long-term medicines or monitoring.
A hole in the gullet lining is usually repaired during the operation but, if it leaks, may need further treatment.
Because achalasia is not cured, long-term follow-up, sometimes including periodic endoscopy, is usually needed.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Clear written diet advice for the staged return to normal food, with dietitian support if needed.
Specific warning signs (chest pain, fever, inability to swallow, vomiting blood) and what to do.
A named contact and out-of-hours number for problems.
Review of swallowing and any reflux, with a plan for treating reflux if it develops.
A long-term follow-up plan, including periodic endoscopy where advised, given the small cancer risk in achalasia.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Surgeon's and anaesthetist's fees
Tests needed beforehand, such as gastroscopy, manometry and a barium swallow
Theatre/facility time and the length of hospital stay
Whether the operation is keyhole or open, and whether a partial wrap is added
Complexity, such as a very dilated gullet or previous treatment
Long-term follow-up, including any periodic endoscopy
The policy if a complication occurs or further treatment (such as balloon stretching) is later needed

Make sure your written quote includes

The surgeon's fee and the anaesthetist's fee
The cost of pre-operative tests (gastroscopy, manometry, barium swallow)
The hospital/facility and theatre fee, and expected length of stay
Whether the anti-reflux wrap is included
Follow-up appointments, including any long-term endoscopy
The cancellation policy
What happens, and who pays, if there is a complication or further treatment is needed later

On the NHS? Surgery for achalasia is available on the NHS, usually in specialist upper GI centres; private care is sometimes chosen for speed or choice of surgeon, and the condition is best managed where there is expertise in all the treatment options.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

How many achalasia operations do you do, and is this a specialist centre for it?
Would Heller's myotomy, POEM or balloon stretching suit my type of achalasia best?
How will you reduce the chance of acid reflux afterwards?
How likely is my swallowing difficulty to return, and what would we do if it did?
What would you do if a hole was made in the gullet during surgery?
What long-term follow-up, including endoscopy, will I need?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Will this cure my achalasia?

No. Achalasia cannot be cured. Heller's myotomy relieves the blockage by cutting the tight muscle so swallowing improves, but it does not restore normal gullet movement. The aim is durable improvement in symptoms, not a cure, and ongoing follow-up is needed.

How is Heller's myotomy different from POEM?

Both cut the tight muscle. Heller's myotomy is done by keyhole through the tummy and usually adds an anti-reflux wrap, so causes less reflux. POEM is done through the mouth with no tummy cuts and may relieve swallowing even more, but tends to cause more acid reflux. The best choice depends on the achalasia type and local expertise.

Will I get acid reflux afterwards?

Cutting the muscle can let acid flow back up, which is why a partial wrap is usually added to reduce this. Even so, some people develop reflux or heartburn afterwards and may need long-term acid-suppressing medicines. Report new or persistent heartburn so it can be treated.

Could my swallowing problems come back?

Possibly. The operation relieves the blockage but does not restore normal gullet movement, so a proportion of people have swallowing difficulty that returns over the years. This may be helped by balloon stretching or, in some cases, further treatment.

Can this be done on the NHS?

Yes. Surgery for achalasia is available on the NHS, usually in specialist upper GI centres. Private care may be chosen for speed or choice of surgeon, but achalasia is best managed where there is specialist expertise in all the treatment options.

What are the alternatives to surgery?

The main alternatives are stretching the muscle with a balloon (pneumatic dilatation) and POEM. Botox injection is mainly for people not suited to other treatments, as its effect wears off. The right choice depends on your achalasia type, age, health and local expertise.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: POEM treatment for achalasia — University Hospital Southampton NHS (PDF) Endoscopic or surgical myotomy in idiopathic achalasia — randomised trial (NEJM) POEM vs laparoscopic Heller myotomy and pneumatic dilation — systematic review (PMC) Long-term outcomes of laparoscopic Heller myotomy vs POEM (Wiley) POEM: literature review and the first UK case series (PMC) British Society of Gastroenterology

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.