POEM and Heller Myotomy?

Posted , 3 users are following.

I had the HM back 2012 before the POEM was popular, at least where I'm from. I was wondering if anyone knew if you've had the HM, can you have the POEM surgery at a later date to help?  Or are they relatively the same surgery just different procedures?  Just curious since the HM didn't help near like I was hoping. 

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  • Posted

    The POEM procedure cuts the muscles with an endoscopic device inside the lining of the oesophagus, whereas the Heller's myotomy surgery cuts the muscles through the lining.   So once the HM has been done it is very unlikely that POEM would be possible, but I am not qualified to give a proper opinion.

    ?If your surgery has not been successful to the degree that you had hoped, there may be a number of reasons.   Perhaps the surgeon did not cut enough length of the muscle, or the fundoplication wrap is not working at the optimum level.   These things are judgements, and surgeons will sometimes act conservatively for understandable reasons.   Returning to the specialist for renewed barium meal and manometry analysis would help understand the residual problems, and perhaps clarify what, if anything, can realistically be done.   Repeating surgery can be a tricky thing, however, and it is only specialist surgeons who could advise. 

    ?In achalasia there is not really a cure as such;  the surgery relieves the symptoms and allows gravity to achieve the swallowing function that would otherwise be done with peristaltic muscles.

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    • Posted

      Thank you for your reply! I didn't think POEM was an option after having the HM. I'm just frustrated, but I guess I should be thankful. Thankful that at least I am able to eat most foods and maintain a healthy weight. I think it's the pain and the trouble swallowing that gets me the most. I'm tired of gagging and/or throwing up to get the food to where it needs to be. I had my yearly endo 2wks ago and I see my doctor on June 5th. I guess I'll ask questions then.  Again, thank you!

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  • Posted

    Hello JoyAsh  I had a failed HM back in 2010.   I struggled for five more years, two Botox injections with little success.  After much lost weight and many trips to the ER I learned from my Doctor at Stanford back in 2014, that POEM procedure was a option.  It was a success, I was able to eat again!!  Unfortunately I was still having issues with what I thought was dehydration and vomiting.   I was needing to go to the ER about two or three times a year.  The ER doctor thought maybe it was Gastroparesis, a nerves disorder of the stomach.  Sorry to say he was right.   Back to your question yes POEM can be done after a HM..  If you had the nission floatolation(spelling?) done at time of your surgery, that's a good thing.  Good luck you need to find the right doctor.

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    • Posted

      That's awesome to hear actually! Sorry your HM failed as did mine. It's quite frustrating! I did have the fundoplication (sp?) along with my surgery so glad to hear that's a good thing. I just had my yearly endo in May and I have an appt with my gastro dr in June to discuss other options. I'll be asking about the POEM now that I know it can be done. Thank you so much for your reply!!! 

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