Private laparoscopic Heller myotomy and POEM for achalasia, by a consultant upper GI surgeon.
A definitive treatment for achalasia - laparoscopic Heller with a Dor fundoplication, POEM in specialist centres, or pneumatic dilatation when it fits. The right choice hinges on your manometry subtype, and we say which before you commit.
Indicative pricing
What private achalasia treatment costs in the UK.
Indicative ranges across UK private providers.
In short
£8,000–£14,000, home in one to two nights.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Laparoscopic Heller myotomy + Dor fundoplication | £8,000–£14,000 | 90–180 min GA | 1–2 night stay |
| POEM (per-oral endoscopic myotomy) | £6,000–£10,000 | 60–120 min GA | 1–2 night stay |
| Pneumatic balloon dilatation (per session) | £400–£800 | 30 min sedation | Same day |
| Botulinum toxin injection (EGD) | £800–£1,600 | 20 min sedation | Same day |
| High-resolution manometry (HRM) | £500–£900 | 30 min | Report 3–5 days |
| Timed barium swallow | £300–£500 | 20 min | Report same day |
| Upper GI consultation | £250–£450 | 30–45 min | Same visit |
Prices vary by hospital, by which surgeon or endoscopist does the case, by length of stay, and by whether pre-operative manometry and imaging are already in hand.
The problem
The right surgeon, the right subtype-matched procedure.
Achalasia is rare - most gastroenterologists see only a handful of cases a year, and getting the choice between Heller, POEM and dilatation right depends on the manometry subtype.
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Want it done properly?
A named consultant upper GI surgeon, intraoperative endoscopy on every Heller, and a post-op contrast swallow before you eat.
When it helps
When laparoscopic achalasia surgery is the right step.
The symptoms and diagnostic findings we see most, plus the one red flag that means urgent endoscopy - not a booking.
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Dysphagia to solids AND liquids
Difficulty swallowing both solids and liquids from the start - the hallmark that distinguishes achalasia from a mechanical stricture.
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Regurgitation of undigested food
Bringing back food eaten hours earlier, often at night - a sign the oesophagus is not emptying.
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Chest pain, especially type III
Spastic-type achalasia (Chicago type III) causes chest pain that mimics cardiac disease - POEM is often the preferred option.
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Unintentional weight loss
Weight loss because eating is slow, painful or provokes regurgitation - a marker of disease severity.
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Bird’s-beak on barium swallow
The classic tapered lower oesophagus with a dilated body - a strong pointer to achalasia, confirmed by manometry.
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HRM-confirmed types I, II or III
Chicago Classification v3.0 defines the subtype - it drives whether Heller, POEM or balloon dilatation is best.
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Failed pneumatic dilatation
Recurrent symptoms after one or two balloon dilatations usually mean it is time for definitive myotomy.
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Red flag: sudden weight loss + age >55
Rapid-onset dysphagia and weight loss over 55 needs urgent endoscopy to rule out pseudo-achalasia from tumour before any dilatation or myotomy.
Treatment options
Heller myotomy is not the only option.
What each option on the table actually involves - and which fits which subtype.
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Laparoscopic Heller myotomy + Dor
The workhorse for types I and II. Longitudinal myotomy 6 cm up the oesophagus and 2–3 cm onto the stomach, with an anterior partial fundoplication to control reflux. 85–90% symptom-free at 5–10 years.
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Heller + Toupet posterior fundoplication
An alternative partial wrap (270° posterior) - some surgeons prefer it for reflux control. Nissen 360° is avoided after Heller due to obstruction risk.
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POEM (per-oral endoscopic myotomy)
A tunnelled endoscopic myotomy with no external incisions. Particularly good for type III (spastic) because the myotomy can be extended through the spastic segment. Limited to specialist UK centres.
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Pneumatic balloon dilatation
Outpatient endoscopic stretching of the lower oesophageal sphincter. Effective for types I and II; multiple sessions may be needed and perforation risk is 2–6%. Less used in the UK since POEM.
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Botulinum toxin injection (EGD)
A temporary option - injected into the lower oesophageal sphincter at endoscopy. Effect wears off over 6–12 months. Best for very frail patients unfit for definitive treatment.
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Oesophagectomy
Last-resort surgery for end-stage megaoesophagus (sigmoid oesophagus) after failed myotomy and dilatation. Rarely needed if achalasia is treated early.
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Redo myotomy
For symptom recurrence after Heller or POEM. Usually performed in the opposite plane - laparoscopic Heller after POEM, or POEM after Heller - at a specialist centre.
Safety and recovery
What to expect afterwards - honestly.
Laparoscopic Heller and POEM are safe in experienced hands. The things worth planning are subtype-matched choice, the graded diet, and knowing what is normal after.
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General anaesthetic in a proper theatre
Both laparoscopic Heller and POEM need GA. A pre-op assessment covers fitness, medications and any prior abdominal surgery.
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Mucosal perforation is the main intra-op risk
Around 5–10% of Heller myotomies have a small mucosal injury during the procedure. Recognised and repaired at the time, it does not affect long-term outcome.
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Reflux after myotomy is common
Around 30–40% get reflux after Heller without a wrap, 10–20% with a Dor. POEM (no fundoplication) has 40–60% reflux - long-term PPI is often needed.
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A contrast swallow before eating
A water-soluble contrast swallow the next morning confirms no leak before liquids are started. Standard for both Heller and POEM.
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Diet progresses in stages
Clear liquids for the first 24 hours, full liquids 1–2 weeks, soft diet 2–4 weeks, normal texture 4–6 weeks. Rushing the progression risks disruption.
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Persistent dysphagia in 5–15%
A minority still struggle to swallow after myotomy - usually from an incomplete myotomy or scarring. Balloon dilatation or a redo procedure can help.
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Rare but serious complications
Pneumothorax, splenic injury, bleeding, DVT/PE and (rarely) mediastinitis after POEM. All uncommon in experienced centres.
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Long-term surveillance
Even after successful treatment, achalasia carries a small long-term risk of oesophageal cancer - periodic endoscopic surveillance is discussed.
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Red flags
Fever, chest or abdominal pain out of proportion, shortness of breath or vomiting blood after surgery are not normal - call the team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon or endoscopist sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis and subtype
Achalasia confirmed on HRM with Chicago Classification subtype (I classic, II panoesophageal pressurisation, III spastic), and any imaging findings such as bird’s-beak.
- 02 Technique
Procedure performed
Whether laparoscopic Heller with Dor or Toupet, POEM (with tunnel length and orientation), or pneumatic dilatation with balloon size and pressures.
- 03 Findings
Myotomy length, mucosal integrity, wrap
Total myotomy length (typically 7–8 cm), intraoperative endoscopy findings, any mucosal injury and repair, and the fundoplication constructed.
- 04 Impression
Recovery, diet stages, reflux plan
Read this first: diet progression, when to restart normal activity, whether PPI is recommended, and follow-up timing for barium swallow.
Recognised by major UK insurers
Cover for achalasia surgery is standard on most UK PMI policies with a valid GP or consultant referral.
Frequently asked
Everything we get asked about achalasia surgery.
Quick answers on diagnosis, Heller versus POEM, cost, reflux and long-term results.
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What is achalasia and how is it diagnosed?
Achalasia is a rare motility disorder where the lower oesophageal sphincter fails to relax and the oesophageal body loses peristalsis. Diagnosis needs high-resolution manometry (HRM) - the gold standard, subtyped by Chicago Classification v3.0 into type I (classic), type II (panoesophageal pressurisation) and type III (spastic). Endoscopy rules out a tumour mimicking achalasia (pseudo-achalasia), and a timed barium swallow shows the classic tapered "bird’s-beak" appearance and measures how well the oesophagus empties.
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Heller myotomy or POEM - which is better?
For types I and II, laparoscopic Heller with an anterior partial (Dor) fundoplication and POEM give comparable symptom control (85–90% at 5 years). Heller has less reflux because of the wrap. For type III (spastic) POEM is generally preferred because the myotomy can be extended along the spastic oesophageal segment, which is not practical with Heller. Choice also depends on prior surgery, body habitus and the availability of a POEM-trained centre.
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How much does laparoscopic Heller cost privately in the UK?
Roughly £8,000–£14,000 for laparoscopic Heller with Dor fundoplication, including hospital, surgeon, anaesthetist and one to two nights’ stay. POEM is £6,000–£10,000 in the small number of UK centres offering it. Balloon dilatation is £400–£800 per session.
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What is the recovery like after Heller myotomy?
One to two nights in hospital, a contrast swallow the next morning, then clear liquids. Full liquids for 1–2 weeks, soft diet 2–4 weeks, normal texture at 4–6 weeks. Office work in 1–2 weeks, driving in 1–2 weeks, no heavy lifting or strenuous exercise for 6 weeks. A follow-up appointment at 6–8 weeks with a repeat barium swallow.
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Will I get reflux after achalasia surgery?
Some reflux is common - the myotomy weakens the anti-reflux valve. Heller with a Dor wrap gives 10–20% reflux, Heller without a wrap 30–40%, and POEM (no wrap possible) 40–60%. Long-term PPI is often needed after POEM. The Dor is preferred over Nissen 360° because a full wrap can cause obstruction after myotomy.
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Can pneumatic dilatation be used instead of surgery?
Yes, for types I and II. It is done at endoscopy under sedation using a graded balloon (30, 35, 40 mm). Success is 60–80% at 5 years but many patients need repeat sessions, and perforation risk is 2–6%. UK use has fallen since POEM became available, but it is still a valid option, particularly for older patients or those who want a non-surgical route first.
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How successful is laparoscopic Heller myotomy long term?
In experienced hands, 85–90% of patients are symptom-free or much improved at 5 years, and 80–85% at 10 years. Persistent or recurrent dysphagia occurs in 5–15% - usually from an incomplete myotomy or scarring, and often treatable with balloon dilatation or a POEM as a second-line procedure.
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When should I see a specialist urgently?
Sudden onset dysphagia and weight loss over the age of 55 needs urgent endoscopy to rule out oesophageal cancer masquerading as achalasia (pseudo-achalasia). Vomiting blood, severe chest pain after any dilatation or myotomy, fever or shortness of breath after surgery are all reasons to seek same-day medical help.
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