A 32-year-old woman presents with progressive dysphagia to both solids and liquids, with occasional regurgitation of undigested food and nocturnal cough. Barium swallow shows a dilated oesophagus tapering smoothly to a bird-beak deformity. High-resolution manometry shows impaired lower oesophageal sphincter relaxation with absent peristalsis. After failed pneumatic dilation, which operation offers durable relief?
- A Heller cardiomyotomy, often combined with partial fundoplication ✓
- B Truncal vagotomy with gastrojejunostomy
- C Nissen fundoplication
- D Oesophagectomy with gastric pull-up
Correct answer: A. Heller cardiomyotomy, often combined with partial fundoplication
Explanation
Achalasia is characterised by absent peristalsis and failure of lower oesophageal sphincter relaxation. Surgical treatment is a longitudinal myotomy across the hypertensive lower sphincter (Heller procedure), usually with an anterior Dor or posterior Toupet partial fundoplication to prevent reflux while avoiding dysphagia from a complete wrap. Nissen fundoplication is wrong because it increases resistance at the cardia and would worsen dysphagia in aperistaltic oesophagus.
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.