A 34-year-old woman with dysphagia to both liquids and solids has oesophageal manometry showing incomplete relaxation of the lower oesophageal sphincter and absent peristalsis in the distal oesophagus. She undergoes laparoscopic cardiomyotomy. Which additional step is routinely performed to reduce postoperative gastro-oesophageal reflux?
- A Nissen 360-degree fundoplication
- B Dor anterior fundoplication ✓
- C Truncal vagotomy with pyloroplasty
- D Collis gastroplasty
Correct answer: B. Dor anterior fundoplication
Explanation
Heller myotomy divides the lower oesophageal sphincter and abolishes its antireflux function, so a partial antireflux wrap is added. The Dor anterior fundoplication is the conventional choice after cardiomyotomy because it covers the exposed mucosa and buttresses the myotomy without adding resistance to outflow in an aperistaltic oesophagus. B full Nissen wrap causes dysphagia here. Collis gastroplasty addresses short oesophagus, not reflux after myotomy.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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