Future victims of achalasia — a rare disease that makes it difficult to eat and can cause drastic weight loss — may no longer have to wear scars after surgery. Surgeons at UCSD Medical Center have performed the first successful incision-free myotomy in the U.S.
A myotomy is a surgery designed to reverse the effects of achalasia, which directly impacts the esophagus — the muscles lining the inside of the throat — by inhibiting the ability to swallow and making it difficult for patients to carry food down their stomachs. In addition, the lower esophagus sphincter — the muscle that relaxes to let food through, then contracts to keep stomach acids from backing into the esophagus — tightens, making it difficult for food to get to the stomach. When this happens, achalasia patients can experience chest pains, and often regurgitate their food.
John Slepicka, a patient who offered himself up for the trial noninvasive surgery, lost 30 pounds over the two years that he suffered from achalasia, and found that other surgeries did not work for him.
“Over time, I could not eat the foods I love,” Slepicka said. “I could no longer go to restaurants. My friends said I looked unhealthy. When I tried to eat, the food would get stuck in my throat. I would swallow air or stand up to get the food down.”
According to Santiago Horgan, chief of minimally invasive surgery at UCSD and the doctor who performed the myotomy, there are two ways achalasia can manifest. The first is through a parasitic infection — more common with patients in Latin America. In the U.S., however, achalasia is primarily a genetic disease.
Traditionally, to treat achalasia, surgeons made incisions in patients’ chests to gain access to the esophagus and stomach. Then, using laparoscopic techniques — smaller incisions and the use of magnifying lenses on probes inside the body — doctors cut long slits along the outer layer of the esophageal muscles.
These surgeries started from the lower esophagus sphincter and continued into the stomach, allowing food to pass through uninhibited. They required several days’ recovery time and often left scarring.
When performing the minimally invasive surgery, Horgan and his team still made the incisions laparoscopically — only this time, they went in through the mouth instead of a cut in the chest cavity.
“With prior surgeries, my post-operative pain was a 13 on a scale of one to 10,” Slepicka said. “Because this surgery was done without cuts, I don’t feel like I’ve even had a procedure.”
Horgan said he hopes the surgical innovation will mean shorter recovery time, less pain and smaller risk of infection for patients. If so, according to Horgan, the procedure could become a standard treatment for achalasia.
“The surgery is still in its trial stages,” Horgan said. “Only time will tell if it involves fewer risks.”
In 2008, alongside Dr. Gareth Jacobson (who also helped perform the recent myotomy) Horgan performed California’s first minimally invasive gastric bypass through a patient’s mouth. Horgan then made headlines that same year when he performed an appendectomy by removing a patient’s appendix through her vagina and mouth.
“With dramatic advancements in medical devices, we can now perform complex surgeries through the mouth with no external incisions,” Hogan said. “What we are seeing is the evolution of laparoscopic surgery into more specialized procedures that require no incisions at all. I believe that minimally invasive surgery is the future of surgeries. We can very well see incisionless heart or brain surgery in the coming 20 to 30 years.”
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