A Heller myotomy is a surgical procedure for treating achalasia, a rare esophageal motility disorder where the lower esophageal sphincter (LES) fails to relax properly, making it difficult to swallow food and liquids. After the surgery, the patient's diet requires a careful, staged progression to ensure the healing esophagus is not stressed and to prevent complications. This phased approach is a cornerstone of a successful recovery and long-term symptom relief.
The Phased Dietary Approach
Recovery from a Heller myotomy typically involves a gradual transition through different food textures, often guided by your surgical team. This process allows for initial healing and gradually prepares your swallowing mechanism for a normal diet. Advancing too quickly can cause discomfort, blockages, or other issues.
Phase 1: Clear Liquids (First 1–2 Days)
Immediately after surgery, the diet consists of clear, see-through liquids. This phase helps reintroduce oral intake without straining the surgical site.
- Allowed: Water, clear broths (chicken or beef), apple juice, cranberry juice, clear sports drinks (without carbonation), gelatin (Jell-O), and ice pops.
- Avoid: Carbonated beverages, citrus juices, and alcoholic drinks.
Phase 2: Full Liquids (Days 3–7)
Once clear liquids are well tolerated, the diet progresses to full liquids. These are thicker and provide more nutrients.
- Allowed: Milk, soy milk, plain yogurt (without fruit chunks), smooth, strained cream soups, ice cream, pudding, and protein shakes.
- Avoid: Lumpy soups, yogurts with fruit pieces, and sugary desserts.
Phase 3: Pureed Diet (Week 2)
After about a week, the diet moves to pureed foods, which have a smooth, consistent texture similar to baby food. A food processor or blender is necessary for this stage.
- Allowed: Blended or smooth-textured scrambed eggs, pureed meats moistened with gravy, hummus, mashed potatoes, well-cooked and pureed vegetables, and smooth applesauce.
- Avoid: Any foods with lumps, skin, or seeds, such as corn or peas.
Phase 4: Soft Diet (Weeks 3–6)
The soft diet phase allows for the introduction of more solid foods that are moist and easy to chew. Foods should be well-cooked and cut into small pieces.
- Allowed: Baked or moist fish, scrambled eggs, soft pasta with sauce, well-cooked vegetables without skins, and bananas.
- Avoid: Tough meats, crusty bread, raw vegetables, and sticky foods like fresh doughy bread or donuts.
Phase 5: Gradual Reintroduction to a Regular Diet (Week 6+)
Around six to eight weeks post-surgery, you can begin to reintroduce more regular foods, paying close attention to your body's response. Some foods may still pose challenges and should be introduced slowly.
Long-Term Dietary Habits
Even after a full recovery, adopting new eating habits can prevent long-term swallowing issues or reflux.
- Chew Thoroughly: Always cut food into small pieces and chew it very well to ease passage through the esophagus.
- Eat Slowly: Taking your time with meals reduces the risk of food getting stuck and allows your body to adjust.
- Small, Frequent Meals: Eating smaller portions throughout the day can prevent the feeling of fullness and bloating.
- Drink Between Meals: While sipping liquids during meals can help with swallowing, avoid drinking large volumes with food as it can cause early fullness.
- Sit Upright: Stay in an upright position while eating and for at least 30 to 60 minutes afterward to aid digestion and prevent reflux.
Foods to Avoid After Heller Myotomy
Certain foods are known to cause issues like reflux, bloating, or swallowing difficulty, even after the initial healing period. It's best to reintroduce these cautiously or avoid them altogether.
- Gas-Producing Foods: Avoid broccoli, beans, peas, onions, and cabbage, which can cause bloating and discomfort.
- Sticky Foods: Steer clear of things like fresh, doughy bread, bagels, and sticky candy, which can cling to the esophagus.
- High-Reflux Items: Spicy foods, alcohol, caffeine, chocolate, and citrus should be limited or avoided if they trigger heartburn.
- Carbonated Drinks: Fizzy drinks can cause significant bloating and gas due to the air they contain.
- Tough, Dry Foods: Tough meats and crusty breads can be difficult to swallow and may get stuck.
Diet Progression: Pre-Surgery vs. Post-Surgery
| Feature | Before Heller Myotomy | After Heller Myotomy |
|---|---|---|
| Swallowing | Significant difficulty with both solids and liquids | Improved, but requires conscious effort and adapted habits |
| Food Consistency | Often limited to soft or liquid due to achalasia | Progressive stages from liquids to soft, then regular foods |
| Eating Speed | Slow eating and chewing to overcome LES resistance | Slow eating and thorough chewing to manage healing esophagus |
| Meal Frequency | Variable; often struggled with full meals | Recommended to eat small, frequent meals to prevent discomfort |
| Liquid Intake | Often used to help push food past the tight sphincter | Primarily between meals; small sips during meals to assist |
| Foods to Avoid | Foods based on individual swallowing tolerance | Gas-producing, sticky, and high-reflux foods to prevent side effects |
Conclusion
Following a structured, phased diet after Heller myotomy is essential for a successful recovery and for achieving long-term relief from achalasia symptoms. By adhering to the dietary stages, incorporating careful eating habits, and being mindful of trigger foods, patients can minimize post-surgical discomfort and safely return to a more varied diet. Listening to your body and consulting with your healthcare team at every stage is crucial for an optimal outcome. The transition back to a regular diet is a gradual process, but with patience and the right approach, it can lead to a significant improvement in quality of life.
For more detailed dietary instructions, you can refer to the patient resources from Weill Cornell Medicine's Department of Surgery, which provides a comprehensive post-myotomy diet plan.
