Heller Cardiomyotomy

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

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

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.

Achalasia:

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.

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.

Ans. is ‘a’ i.e., Achalasia cardia

• Heller’s operation is done for Achalasia cardia of the oesophagus.
• In Heller’s operation extramucosal oesophago-cardiomyotomy is performed.

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.”

Ans. i.e., ‘a’ (Mostly in women )

Answer is A (Achalasia Cardia)

Heller’s extramural myotomy of the LES is performed for Achalasia cardia and involves incising the circular muscle layer.

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.

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,