Short Quiz on Heller Cardiomyotomy


1. This Test has 7 Questions 
2. There is 1 Mark for each correct Answer

MCQ – 1

Heller’s operation is done for?

Gastric outlet obstruction
Achalasia cardia
Hiatal hernia
Esophageal spasms
Explanation :

Achalasia cardia REF: CSDT 11TH ed p. 478, bailey 24th ed p. 1019

Extramucosal cardiomyotomy or Heller’s myotomy is performed laparoscopically with video is done for achalasia cardia

MCQ – 2

A lady presents to you with complaints of dysphagia to both solids and liquids along with episodes of intermittent chest pain. Barium swallow done in her shows a dilated lower esophagus. What is the best modality of treatment in her?




Heller’s myotomy

Explanation :

This patient is suffering from achalasia cardia an esophageal motility disorder caused by the loss of ganglion cells withing esophageal myentric plexus.

Best method of treatment in her would be Heller’s myotomy usually done along with partial fundoplication.



Clinical features: Patients often presents with dysphagia, chest pain, regurgitation and weight loss.

Investigations: Barium swallow shows a dilated esophagus with poor emptying, an air fluid level and tapering at LES giving a bird beak appearence. Esophageal manometry shows impaired LES relaxation and absent peristalsis.

Management : Pharmacologic therapy: Drugs which are temporarily used to relieve the LES pressure are : nitrates, calcium channel blockers or botulinum toxin.

Surgical procedures: Pneumatic dilatation and Heller’s myotomy are the only durable therapies.

Ref: Harrison’s Principles of Internal Medicine, 18th Edition chapter 292.

MCQ – 3

Heller myotomy is used in:

Esophageal atresia



None of the above

Explanation :

A laparoscopic Heller myotomy and partial fundoplication is the procedure of choice for esophageal achalasia.
The operation consists of a controlled division of the muscle fibers (ie, a myotomy) of the lower esophagus (5 cm) and proximal stomach (2 cm), followed by a partial fundoplication to prevent reflux.

MCQ – 4

A female patient has dysphagia, intermittent epigastric pain. On endoscopy, esophagus was dilated above and narrow at the bottom. Treatment is:




Heller’s Cardiomyotomy

Explanation :

Ans is `d’ i.e. Heller’s Cardiomyotomy 
This patient is having Achalasia cardia.

  • “A laparoscopic Heller myotomy and partial fundoplication is the procedure of choice for esophageal achalasia. 
  • A laparoscopic Heller myotomy allows excellent relief of symptoms in the majority of patients and should be preferred to pneumatic dilatation whenever surgical expertise is available.
  • Botulinum toxin and medications should be used only in patients who are not candidates for pneumatic dilatation or laparoscopic Heller myotomy.”
  • Laparoscopic Heller myotomy is now the operation of choice.

MCQ – 5

About achalasia cardia all are correct except- 

Mostly in women

Dilated esophagus narrowing to a point

Heller’s operation treatment of choice


Explanation :

Ans. i.e., ‘a’ (Mostly in women )

MCQ – 6

Heller’s myotomy is done for:

Esophageal carcinoma

Pyloric hypertrophy

Achalasia cardia

Inguinal hernia

Explanation :

Ans. C: Achalasia cardia

Achalasia is associated with loss of ganglion cells in the esophageal myenteric plexus.

These important inhibitory neurons induce LES relaxation and coordinate proximal-to-distal peristaltic contraction of the esophagus

Achalasia is an esophageal motor disorder characterized by increased lower esophageal sphincter (LES) pressure, diminished-to-absent peristalsis in the distal portion of the esophagus composed of smooth muscle, and lack of a coordinated LES relaxation in response to swallowing.

Barium radiology may show ‘bird’s beak’ appearance.

Esophageal (Heller) myotomy is a surgical procedure that is performed with minimally invasive techniques. The laparoscopic approach appears to be most appropriate.

MCQ – 7

Identify the surgical procedure as shown in the picture below ? 

Heller myotomy.

William myotomy.

Both of the above.

None of the above.

Explanation :

The surgical procedure as shown in the picture above represents Heller myotomy.

Heller myotomy is a surgical procedure in which the muscles of the cardia are cut, allowing food and liquids to pass to the stomach. It is used to treat achalasia,

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