Achalasia Treatment in Melbourne
Achalasia is a rare oesophageal motility disorder in which the lower oesophageal sphincter fails to relax during swallowing, preventing food and liquid from passing into the stomach.
The condition affects approximately 1 in 100,000 adults per year and, without treatment, leads to progressive dysphagia (difficulty swallowing), regurgitation, chest pain, and unintentional weight loss [1].
At Specialist Surgical Group, our Melbourne-based upper gastrointestinal surgeons offer evidence-based surgical treatment for achalasia. We perform laparoscopic Heller myotomy with partial fundoplication and per-oral endoscopic myotomy (POEM), selecting the most appropriate approach based on your achalasia subtype, age, and overall health.
Find more information about our upper GI surgery services.
We consult from our Essendon and Bundoora clinics, with procedures performed at accredited hospitals in Melbourne.
Call us today at (03) 9466 7338 to book a consultation.
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We are located in the heart of Essendon and Bundoora.
Is achalasia treatment for you?
Achalasia treatment is generally recommended for people who experience one or more of the following:
- Persistent difficulty swallowing both solid foods and liquids
- Regular regurgitation of undigested food, particularly at night
- Chest pain not related to cardiac conditions
- Unintentional weight loss caused by eating difficulties
- Frequent coughing or choking, especially when lying down
- Heartburn that does not respond to standard acid reflux treatments
Your suitability will be confirmed during a full assessment, which includes oesophageal manometry, a barium swallow study, and upper endoscopy. During the consultation, we will discuss whether surgical treatment is the most appropriate option for your circumstances.
Potential benefits
- High clinical success rates. The large majority of patients achieve significant and sustained improvement in swallowing function following laparoscopic Heller myotomy or POEM, with 5-year success rates of 80–90% reported in the literature [2].
- Long-term symptom relief. Studies demonstrate sustained oesophageal clearance and symptom relief for 5 or more years following treatment, with the Eckardt symptom score remaining low in most patients [3].
- Low procedure-related mortality. POEM carries a reported mortality rate of zero in recent systematic reviews, and laparoscopic Heller myotomy is similarly well established as a safe intervention in experienced hands [4].
- Improved quality of life. Patients consistently report meaningful improvements in social dining, family meals, and daily activities following successful treatment for achalasia [2].
- Tailored surgical approach. We select between laparoscopic Heller myotomy with partial fundoplication and POEM based on your specific achalasia subtype (Type I, II, or III), which directly influences the likelihood of a successful outcome [5].
Potential risks
- Gastro-oesophageal reflux. Post-treatment reflux is the most common longer-term concern. Reflux rates are generally lower following laparoscopic Heller myotomy with fundoplication than after POEM [6]. Most cases are effectively managed with proton pump inhibitor medications [6].
- Oesophageal perforation. Mucosal injury during the myotomy is an uncommon but recognised complication of both procedures. When identified intraoperatively, it is repaired immediately and typically does not affect long-term outcomes [4].
- Persistent or recurrent symptoms. A minority of patients experience ongoing dysphagia or symptom recurrence requiring further intervention, such as endoscopic pneumatic balloon dilation or repeat myotomy [7].
- Incomplete myotomy. Failure to fully divide the muscular fibres of the lower oesophageal sphincter may result in residual symptoms. This is more common in technically challenging cases and can be assessed with post-operative oesophageal testing [8].
- General surgical risks. Standard risks, including bleeding, infection, and anaesthesia-related complications, apply to both procedures. Our minimally invasive techniques help minimise these risks [8].
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(03) 9466 7338Meet our Upper GI surgeons
Your achalasia treatment journey
The following steps provide a brief overview of your achalasia treatment journey. Individual experiences will vary based on your specific health circumstances.
1. Initial consultation and health assessment
Your surgeon will take a detailed history of your symptoms, including the duration and severity of your swallowing difficulties, regurgitation, chest pain, and any unintentional weight loss.
A physical examination will be performed, and any prior test results will be reviewed. If diagnostic testing has not yet been arranged, your surgeon will explain what is needed and coordinate the appropriate referrals.
2. Pre-operative preparation and diagnostic workup
Confirming the diagnosis of achalasia requires a combination of specialised investigations. Oesophageal high-resolution manometry is the gold standard test and identifies your specific achalasia subtype (Type I, II, or III), which directly informs the choice of surgical technique [5].
A barium swallow study and upper endoscopy are also performed to assess oesophageal anatomy and exclude other conditions, such as a hiatal hernia or oesophageal mass.
Once your diagnosis and subtype are confirmed, your surgeon will discuss the most appropriate treatment approach. Your general health will be optimised before surgery, and you will receive clear pre-operative instructions covering fasting requirements and any medication adjustments.
3. The surgical procedure
Both procedures are performed under general anaesthesia at an accredited Melbourne hospital and work by dividing the muscular fibres of the lower oesophageal sphincter to restore normal swallowing.
- Laparoscopic Heller myotomy uses 4–5 small abdominal incisions to access and divide the sphincter muscle, with a partial fundoplication (Dor or Toupet technique) added to reduce post-operative reflux. It takes 90–120 minutes.
- POEM is performed entirely through the mouth using a flexible endoscope: a submucosal tunnel is created in the oesophageal wall, the sphincter muscle is divided from within the tunnel, and the entry point is closed with clips. No external incisions are required, and the procedure takes 60–90 minutes.
4. Hospital recovery
Most patients are admitted to the hospital for 1–2 nights following their procedure. Clear fluids are commenced within the first 24 hours, progressing to free fluids as tolerated.
Pain is generally well controlled with oral analgesia, and most patients are comfortable and mobile within hours of waking from anaesthesia.
Before discharge, our nursing team will provide you with written instructions covering your diet, medications, activity restrictions, and wound care (where applicable). A follow-up appointment will be scheduled prior to leaving the hospital.
5. Dietary progression and recovery at home
A soft diet is followed for the first 1–2 weeks at home, then gradually returned to normal foods over 4–6 weeks. Your surgeon will provide specific dietary guidance based on your progress at the 2-week post-operative review.
Most patients return to light daily activities within 1 week and resume normal activities within 2–4 weeks. Heavy lifting and strenuous exercise are restricted for 4–6 weeks following laparoscopic surgery.
6. Long-term follow-up and monitoring
Follow-up appointments are scheduled at 2 weeks, 3 months, 6 months, and annually thereafter. At each visit, your surgeon will assess your swallowing function using the Eckardt score and review any reflux symptoms or recurrence [5].
Periodic oesophageal testing, including repeat manometry or a timed barium swallow, may be arranged if clinically indicated.
Achalasia is a lifelong condition, and ongoing monitoring is an important part of ensuring the best long-term outcomes. Our team remains available throughout your recovery to address any questions or concerns.
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(03) 9466 7338Achalasia treatment FAQ
Achalasia treatment costs vary depending on the procedure performed, your private health insurance, and the hospital where the procedure is performed. Both laparoscopic Heller myotomy and POEM attract Medicare rebates when performed for a confirmed diagnosis of achalasia. Private health insurance typically covers associated hospital and anaesthesia fees, subject to your level of cover and any applicable waiting periods.
Your specific out-of-pocket costs will be outlined clearly during your consultation. We recommend contacting your insurer ahead of your appointment to confirm your level of cover.
Clinical success rates are high for both laparoscopic Heller myotomy and POEM. Studies report 5-year success rates of 80–90% for both procedures, with the vast majority of patients achieving significant and sustained improvement in swallowing [2][3]. Success rates are influenced by your achalasia subtype; Type II achalasia generally responds best to both surgical approaches [5].
Both procedures divide the lower oesophageal sphincter muscle to relieve obstruction, but they use different approaches. Laparoscopic Heller myotomy is performed through small abdominal incisions and includes a partial fundoplication to reduce reflux.
POEM is performed entirely through the mouth using an endoscope, leaves no external incisions, and is associated with faster recovery in some patients, but carries a higher rate of post-operative reflux compared to Heller myotomy with fundoplication [1][6].
Your surgeon will recommend the most suitable option based on your achalasia subtype and personal circumstances. Patients with co-existing reflux disease may also wish to discuss anti-reflux surgery as part of their broader upper GI assessment.
Post-treatment reflux is a recognised complication of both procedures. Laparoscopic Heller myotomy with partial fundoplication is associated with lower reflux rates than POEM [1]. When reflux does occur following treatment, it is effectively managed with proton pump inhibitor medications in most cases [6].
Most patients return to light daily activities within 1 week and resume their normal routine within 2–4 weeks. A soft diet is followed for 1–2 weeks post-operatively, then gradually returned to normal foods. Full recovery and optimal swallowing outcomes are usually achieved within 3 months of surgery [3].
Achalasia is a chronic neurological condition with no definitive cure. Surgical treatment relieves obstruction and significantly improves symptoms, but the underlying disorder persists. Long-term follow-up is important to monitor for symptom recurrence or complications [7]. A minority of patients require additional treatment over time, such as endoscopic balloon dilation.
The diagnosis of achalasia is confirmed with oesophageal high-resolution manometry, which identifies the specific subtype and guides treatment selection [5]. A barium swallow study and upper endoscopy are also performed to assess oesophageal structure and exclude other conditions. If a hiatal hernia is identified during workup, this will be factored into your treatment planning.
Surgical treatment for achalasia is covered by Medicare when performed for a confirmed diagnosis [9]. Private health insurance typically covers hospital and anaesthesia costs, subject to your level of cover and any applicable waiting periods. Your out-of-pocket costs will be clearly discussed during your consultation. We recommend contacting your fund to confirm your entitlements before your appointment.
A minority of patients experience symptom recurrence following achalasia surgery. Options include endoscopic pneumatic balloon dilation, repeat POEM, or redo laparoscopic Heller myotomy. The most appropriate next step is determined based on your symptoms, the results of post-operative oesophageal function testing, and your previous treatment history [7].
Without treatment, achalasia can lead to progressive oesophageal dilation, recurrent aspiration pneumonia, malnutrition, and a modestly increased risk of oesophageal squamous cell carcinoma over time. In severe or end-stage cases, oesophagectomy may be considered. Early treatment is recommended to prevent progressive and potentially irreversible oesophageal damage [1].
Medical disclaimer
The information on this page is for general educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendations, and does not create a doctor-patient relationship. Individual circumstances vary significantly, and nothing on this page should be used as a substitute for personalised advice from a qualified medical professional.
If you have concerns about your health, please seek medical attention promptly. To discuss your specific condition and treatment options with our team, please book a consultation by calling us at (03) 9466 7338.
References
[1] Vaezi, M.F., et al. (2020). ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. https://doi.org/10.14309/ajg.0000000000000731
[2] Ponds, F.A., et al. (2019). Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients with Achalasia: A Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2019.8859
[3] Moonen, A., et al. (2016). Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. https://doi.org/10.1136/gutjnl-2015-310602
[4] Werner, Y.B., et al. (2019). Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. https://doi.org/10.1056/NEJMoa1905380
[5] Pandolfino, J.E., & Gawron, A.J. (2015). Achalasia: a systematic review. JAMA. https://doi.org/10.1001/jama.2015.2996
[6] Repici, A., et al. (2018). GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2017.10.022
[7] Schlottmann, F., et al. (2018). Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-Analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000002311
[8] Rawlings, A., et al. (2012). Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomised controlled trial. Surg Endosc. https://doi.org/10.1007/s00464-011-1822-y
[9] Australian Government Department of Health and Aged Care. Medicare Benefits Schedule (MBS) Online. https://www.mbsonline.gov.au/