Manometry in a 30-year-old woman with dysphagia to both liquids and solids shows incomplete lower oesophageal sphincter relaxation on swallowing and absent peristalsis in the distal oesophagus. She fails pneumatic dilatation. What is the definitive surgical procedure offered?

• A Nissen fundoplication alone
• B Oesophagectomy with gastric pull-up
• C Heller cardiomyotomy with partial anterior fundoplication ✓
• D Belsey Mark IV repair

Explanation

Achalasia is defined manometrically by impaired LES relaxation and absent distal peristalsis. After failed dilatation, surgical treatment is Heller myotomy, an anterior longitudinal muscle cut across the LES extending onto the cardia, combined with a partial fundoplication (Dor or Toupet) to prevent reflux. A complete 360 degree wrap is avoided because it causes dysphagia in a non-peristaltic oesophagus. Oesophagectomy is reserved for end-stage sigmoid mega-oesophagus.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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