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Heller MyotomyRelated Programs & Sites

General Surgery

Related Conditions

Achalasia

Barrett's Esophagus

Esophageal Cancer

Gastroesophageal Reflux Disease (GERD)

Related Physicians

Section Faculty

Jonathan Carter, M.D.

Stanley J. Rogers, M.D.

The Heller myotomy is a laparoscopic (minimally invasive) surgical procedure used to treat achalasia.

Achalasia is a disorder of the esophagus that makes it hard for foods and liquids to pass into the

stomach.

The Heller myotomy is essentially an esophagomyotomy, the cutting the esophageal sphinctermuscle, performed laparoscopically.

The operation's success rate is very high and usually permanent. A small number of patients may need

addtional treatment.

Description of Procedure

http://general.surgery.ucsf.edu/http://general.surgery.ucsf.edu/http://gi.surgery.ucsf.edu/conditions--procedures/achalasia.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/achalasia.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/barretts-esophagus.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/barretts-esophagus.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/esophageal-cancer.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/esophageal-cancer.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/gastroesophageal-reflux-disease-(gerd).aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/gastroesophageal-reflux-disease-(gerd).aspxhttp://gi.surgery.ucsf.edu/faculty/general-surgeons/jonathan-carter,-md.aspxhttp://gi.surgery.ucsf.edu/faculty/general-surgeons/jonathan-carter,-md.aspxhttp://gi.surgery.ucsf.edu/faculty/general-surgeons/stanley-j-rogers,-md.aspxhttp://gi.surgery.ucsf.edu/faculty/general-surgeons/stanley-j-rogers,-md.aspxhttp://gi.surgery.ucsf.edu/faculty/general-surgeons/stanley-j-rogers,-md.aspxhttp://gi.surgery.ucsf.edu/faculty/general-surgeons/jonathan-carter,-md.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/gastroesophageal-reflux-disease-(gerd).aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/esophageal-cancer.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/barretts-esophagus.aspxhttp://gi.surgery.ucsf.edu/conditions--procedures/achalasia.aspxhttp://general.surgery.ucsf.edu/

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In the procedure, several tiny incisions are made and a small scope inserted, through which miniature

surgical instruments are passed. The scope is connected to a video camera which then sends a

magnified image to a monitor, allowing the surgeon to envsion the anatomy and manipulate the

instruments..

The advantages of the Heller myotomy include:

Less post-operative pain

A 1-2 day hospital stay vs. up to a week with a conventioonal open procedure

Faster recovery from surgery

A more rapid return to work and normal activities

Nissen Fundoplication

Many patients develop gastroesophageal reflux disease (GERD) after a Heller myotomy. To avoid the

development of the condition where contents of the stomach reflux (back up) into the esophagus, a

Nissen fundoplication is may be performed at the same time the esophageal sphincter muscle is cut.

This procedure, alsoperformed laparoscopically, involves wrapping the upper part of the stomach

around the lower esophegeal sphincter to strengthen it.

A Cushing ulceris agastric ulcerproduced by elevatedintracranial pressure.It is also called

vonRokitansky-Cushingsyndrome. Apart from in thestomach,it may also develop in the proximal part of

theduodenumand the distalesophagus.

It is named forHarvey Cushing.[1][2]

Causes[edit]

One possible explanation for the development of Cushing ulcers is the stimulation of vagal nuclei due to

the increasedintracranial pressurewhich leads to increased secretion ofgastric acid.Thevagus

nervereleasesacetylcholine,which stimulates theM3 receptoron the parietal cell and activates the

second messenger to stimulate IP3/Ca2+ to stimulate the Hydrogen/Potassium ATPase pump which will

increase gastric acid production.

It may also be a direct result ofCushing reaction.

Curling's ulceror a Curling ulceris anacutepeptic ulcerof theduodenumresulting as a complication

from severe burns when reducedplasmavolume leads to ischemia and cell necrosis (sloughing) of

thegastric mucosa.The condition was first described in 1823 and named for a doctor,Thomas Blizard

Curling,who observed ten such patients in 1842.[1]

It is also known an GI ulceration. Thesestress

ulcerswere once a common complication of serious burns, presenting in over 10% of cases,[1]

and

http://en.wikipedia.org/wiki/Gastric_ulcerhttp://en.wikipedia.org/wiki/Gastric_ulcerhttp://en.wikipedia.org/wiki/Gastric_ulcerhttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Carl_Freiherr_von_Rokitanskyhttp://en.wikipedia.org/wiki/Carl_Freiherr_von_Rokitanskyhttp://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Esophagushttp://en.wikipedia.org/wiki/Esophagushttp://en.wikipedia.org/wiki/Esophagushttp://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Cushing_ulcer#cite_note-1http://en.wikipedia.org/wiki/Cushing_ulcer#cite_note-1http://en.wikipedia.org/wiki/Cushing_ulcer#cite_note-1http://en.wikipedia.org/w/index.php?title=Cushing_ulcer&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Cushing_ulcer&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Cushing_ulcer&action=edit&section=1http://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Acetylcholinehttp://en.wikipedia.org/wiki/Acetylcholinehttp://en.wikipedia.org/wiki/Acetylcholinehttp://en.wikipedia.org/wiki/M3_receptorhttp://en.wikipedia.org/wiki/M3_receptorhttp://en.wikipedia.org/wiki/M3_receptorhttp://en.wikipedia.org/wiki/Cushing_reactionhttp://en.wikipedia.org/wiki/Cushing_reactionhttp://en.wikipedia.org/wiki/Cushing_reactionhttp://en.wikipedia.org/wiki/Acute_(medical)http://en.wikipedia.org/wiki/Acute_(medical)http://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Gastric_mucosahttp://en.wikipedia.org/wiki/Gastric_mucosahttp://en.wikipedia.org/wiki/Gastric_mucosahttp://en.wikipedia.org/wiki/Thomas_Blizard_Curlinghttp://en.wikipedia.org/wiki/Thomas_Blizard_Curlinghttp://en.wikipedia.org/wiki/Thomas_Blizard_Curlinghttp://en.wikipedia.org/wiki/Thomas_Blizard_Curlinghttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Stress_ulcerhttp://en.wikipedia.org/wiki/Stress_ulcerhttp://en.wikipedia.org/wiki/Stress_ulcerhttp://en.wikipedia.org/wiki/Stress_ulcerhttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Stress_ulcerhttp://en.wikipedia.org/wiki/Stress_ulcerhttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Thomas_Blizard_Curlinghttp://en.wikipedia.org/wiki/Thomas_Blizard_Curlinghttp://en.wikipedia.org/wiki/Gastric_mucosahttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Acute_(medical)http://en.wikipedia.org/wiki/Cushing_reactionhttp://en.wikipedia.org/wiki/M3_receptorhttp://en.wikipedia.org/wiki/Acetylcholinehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/w/index.php?title=Cushing_ulcer&action=edit&section=1http://en.wikipedia.org/wiki/Cushing_ulcer#cite_note-1http://en.wikipedia.org/wiki/Cushing_ulcer#cite_note-1http://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Esophagushttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Harvey_Cushinghttp://en.wikipedia.org/wiki/Carl_Freiherr_von_Rokitanskyhttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Gastric_ulcer

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especially common in child burn victims.[2]

They result in perforation andhemorrhagemore often than

other forms of intestinal ulceration[3]

and had correspondingly high mortality rates.[1]

A similar condition involving elevated intracranial pressure is known asCushing's ulcer.

Treatment[edit]

While emergency surgery was once the only treatment, combination therapies includingenteral

feedingwith powerful antacids such asH2-receptor antagonistsor, more recently,proton pump

inhibitorssuch asomeprazolehave made Curling's ulcer a rare complication.[4]

Kehrov znak je pojava akutne boli u vrhu ramena zbog prisutnosti krvi ili drugih iritansa u peritonealnoj

upljini kad osoba lei i noge su podignute. Kehrov znak se smatra klasinim simptomom rupture

slezene, no moe biti rezultat i dijafragmatske ili peridijafragmatske lezije, renalnih kamenaca, ozljede

slezene ili rupture ektopine trudnoe.

Kehrov znak je klasini primjer referirane (prenesene) boli: osjeaj nadraivanja dijafragme prenosi

frenini ivac (nervus phrenicus) kao bol u podruju iznad kljune kosti. To se dogaa zato to

supraklavikularni ivci (nervi supraclaviculares) imaju isto porijeklo kao frenini ivac, tj. iz C3 i C4 ansae

cervicalis, tj. vratnih spinalnih ivaca.

http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-2http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-2http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-2http://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-3http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-3http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-3http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Cushing%27s_ulcerhttp://en.wikipedia.org/wiki/Cushing%27s_ulcerhttp://en.wikipedia.org/wiki/Cushing%27s_ulcerhttp://en.wikipedia.org/w/index.php?title=Curling%27s_ulcer&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Curling%27s_ulcer&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Curling%27s_ulcer&action=edit&section=1http://en.wikipedia.org/wiki/Feeding_tubehttp://en.wikipedia.org/wiki/Feeding_tubehttp://en.wikipedia.org/wiki/Feeding_tubehttp://en.wikipedia.org/wiki/Feeding_tubehttp://en.wikipedia.org/wiki/H2-receptor_antagonisthttp://en.wikipedia.org/wiki/H2-receptor_antagonisthttp://en.wikipedia.org/wiki/H2-receptor_antagonisthttp://en.wikipedia.org/wiki/H2-receptor_antagonisthttp://en.wikipedia.org/wiki/H2-receptor_antagonisthttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Omeprazolehttp://en.wikipedia.org/wiki/Omeprazolehttp://en.wikipedia.org/wiki/Omeprazolehttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-4http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-4http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-4http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-4http://en.wikipedia.org/wiki/Omeprazolehttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/H2-receptor_antagonisthttp://en.wikipedia.org/wiki/Feeding_tubehttp://en.wikipedia.org/wiki/Feeding_tubehttp://en.wikipedia.org/w/index.php?title=Curling%27s_ulcer&action=edit&section=1http://en.wikipedia.org/wiki/Cushing%27s_ulcerhttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-Pruitt-1http://en.wikipedia.org/wiki/Curling_ulcer#cite_note-3http://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Curling_ulcer#cite_note-2