Having surgery

If you have a condition called achalasia and the muscles in your food pipe do not work properly, we may recommend POEM surgery. This procedure can help your symptoms and improve swallowing by allowing the food pipe to empty.

During the surgery, we cut the muscle fibres in the ring of muscle that lets food and drink into your stomach. They are called the lower oesophageal sphincter muscle fibres.

You have POEM surgery under general anaesthetic. This is a medicine that makes you sleep during the procedure and stops you feeling anything.

You are likely to stay in hospital for 1 or 2 nights.

Pre-assessment

You have a pre-assessment appointment in the outpatient clinic. This is an appointment to make sure that you are:

• fit enough to have a general anaesthetic and the surgery
• fully prepared for the procedure

It's important that you have a liquid-only diet for 3 days before surgery. This is to make sure that your food pipe is empty. 

Your surgeon may still want to do a gastroscopy to look inside and wash out your food pipe on the day of surgery. 

During surgery

POEM surgery is done under general anaesthetic and takes about 2 hours. It involves the following stages.

1. We pass a thin, flexible tube called an endoscope through your mouth.
2. We make a small cut in the lining of the food pipe.
3. We carefully divide the lower oesophageal sphincter muscle fibres.
4. We close the cut in the lining of the food pipe.

The surgery is done inside the food pipe. This means that you do not have a visible cut (incision) or wound. 

After surgery

You stay in the recovery room until you are comfortable and fully awake.

During the surgery, we use carbon dioxide gas to inflate your food pipe. This means that you might feel bloated (full and uncomfortable) or have pain in your chest, neck and tummy.

The carbon dioxide and any pain disappear within a few hours. We give you painkillers during and after surgery, but please tell us if you are uncomfortable.

We move you to a hospital bed, where we regularly check your pulse, blood pressure, temperature and breathing. We encourage you to:

• drink sips of water
• get out of bed
• move around

You have an X-ray the next day to check that the small cut (incision) in your food pipe is sealed. If we are happy with the X-ray results, you can have tea or other drinks.

You usually stay in hospital for 1 or 2 nights. However, if there are any complications, you need to stay in hospital until these are resolved.

Recovery

We ask you to follow a liquid diet (a free-fluid diet) for the first week. While your food pipe heals, you can have:

• any fluids, such as water, clear soups, milk and milk products, or tea and coffee
• any foods that turn to liquid at room temperature, such as plain ice cream

We give you more information about how to follow a free-fluid diet during the first week. After that, you can start eating normal food again.

We give you painkillers when you leave hospital. It is unlikely that you will need strong painkillers after 1 to 2 days.

You need to take 2 weeks off work to recover. If you are well after this time, you can return to all your usual activities.

Follow-up appointment

We make a follow-up appointment with the surgeon or clinical nurse specialist for about 6 weeks after you leave hospital. At this appointment, we check if:

• the surgery has been successful
• you have any reflux symptoms (when stomach acid flows up into your food pipe)

If surgery has not improved your swallowing, we can talk about whether other treatments options might help you. 

After POEM surgery, you do not have any stitches that need to be removed.