A 35-year-old woman presents with progressive dysphagia to both solids and liquids for 2 years, regurgitation of undigested food, and weight loss. Barium swallow shows a dilated esophagus with a 'bird's beak' tapering at the lower esophageal sphincter. Manometry confirms absent peristalsis and incomplete LES relaxation. She is otherwise fit. What is the definitive surgical management?
- A Pneumatic balloon dilation
- B Laparoscopic Heller's cardiomyotomy with partial fundoplication ✓
- C Peroral endoscopic myotomy (POEM)
- D Botulinum toxin injection to the LES
Correct answer: B. Laparoscopic Heller's cardiomyotomy with partial fundoplication
Explanation
Laparoscopic Heller's myotomy with partial (Dor or Toupet) fundoplication is the gold standard surgical treatment for achalasia. It relieves outlet obstruction while reducing post-operative reflux. Pneumatic dilation is a non-surgical alternative. POEM is emerging but not yet the established definitive standard in most Indian exam contexts. Botulinum toxin is temporary and reserved for poor surgical candidates.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.