A 32-year-old woman with idiopathic achalasia is listed for a laparoscopic Heller cardiomyotomy. Why is an anti-reflux procedure added at the same operation?
- A Division of the lower oesophageal sphincter predisposes to gastro-oesophageal reflux, which the wrap controls ✓
- B It improves oesophageal emptying beyond what myotomy achieves alone
- C It prevents recurrence of the dysphagia by maintaining LES tone
- D It reduces the risk of squamous carcinoma developing in the dilated oesophagus
Correct answer: A. Division of the lower oesophageal sphincter predisposes to gastro-oesophageal reflux, which the wrap controls
Explanation
Heller myotomy deliberately destroys the lower oesophageal sphincter mechanism, and without reconstruction a high proportion of patients develop significant reflux. B partial fundoplication, anterior Dor or posterior Toupet, provides reflux control while remaining too loose to cause recurrent dysphagia. B complete 360-degree Nissen wrap is avoided because it can recreate an obstruction at the myotomy site. The wrap does not improve emptying, preserve tone, or alter cancer risk.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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