A 34-year-old woman has six months of dysphagia to both liquids and solids with intermittent regurgitation of undigested food. Endoscopy is normal. High-resolution manometry shows absent peristalsis in the oesophageal body with impaired deglutitive relaxation of the lower oesophageal sphincter. Which intervention addresses the primary pathophysiology?
- A Heller cardiomyotomy with a partial fundoplication ✓
- B Laparoscopic Nissen fundoplication
- C Truncal vagotomy with gastrojejunostomy
- D Collis gastroplasty
Correct answer: A. Heller cardiomyotomy with a partial fundoplication
Explanation
Achalasia is failure of lower oesophageal sphincter relaxation with aperistalsis. Heller myotomy divides the circular muscle at the cardia, directly correcting the non-relaxing sphincter, and a partial (Dor or Toupet) wrap is added because a complete Nissen wrap would obstruct a non-propulsive oesophagus. Collis gastroplasty lengthens a shortened oesophagus in refractory GERD, and vagotomy reduces acid secretion, neither of which touches the motor defect here.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.