Heller's myotomy is done for
(B) Achalasia cardia[?]Achalasia, a disorder of esophagus characterized by progressive inability to swallow solids & liquids.Causes include weakened esophageal muscles & issues with lower esophageal sphincter relaxationHeller Myotomy, surgical procedure offers long term symptomatic relief to these patients.It involves weakening of muscles at gastroesophageal junction, allowing the valve between oesophagus & stomach to remain open.[?]Achalasia Treatment: 2 main methodsHeller's Myotomy:Surgical therapy now involves usually performing only an anterior myotomy, via either abdominal or thoracic approach. In addition to laparosocopic myotomy, thoracoscopic myotomy has also been described.Thoracic approach does have certain drawbacks.Heller's Cardiomyotomy - surgical 7-10 cm long incision made through lower oesophageal end & carried over to stomach, muscles are cut till mucosa bulges out. Myotomy should be extended up to aortic arch & distally up to stomach to 1-2 cm below the junction.Forceful dilatation - using Pneumatic Balloon under fluoroscopic control within LOS (300 mmHg pressure applied for 15 sec).Injection Treatment - Injection Botulinum toxin is injected in LES endoscopically, blocks ACh release.Drugs - Sublingual nifedipine gives short term relief.Endoscopic MyotomyLaparoscopic Heller's Myotomy (LHM):Myotomy from 1.5-3 cm distal to the ECJ dividing the longitudinal & oblique muscle to 6-8cm proximal to the ECJ dividing longitudinal & circular muscle of esophagus.Partial fundoplication is routinely performed as incidence of reflux after Heller's myotomy is >50%.It is due to loss of the ganglion cells in the myenteric (Auerbach's) plexus & cause is unknown.Chaga's disease (due to Trypanosoma cruzi) has marked similarities to achalasia.Other Options[?]Hiatus Hernia:True paraoesophageal hernias with cardia remains in its anatomical position are rare.Vast majority of rolling hernias are mixed hernias in which the cardia is displaced into the chest & greater curve of the stomach rolls into the mediastinum.Elective surgery includes reduction of the hernia, excision of the sac, reducing the crural defect & retention of the stomach in the abdomen.[?]Gastro Oesophageal Reflux Disease:Classical triad of symptoms is retrosternal burning pain (heartburn), epigastric pain (sometimes radiating through to the back) and regurgitation.GORD treated by medical management by proton pump inhibitor therapy +H2 receptor antagonists.Surgery includes;1. Allison repair of hiatus hernia; 2. Nissen fundoplication; 3. Hill procedure; 4. Belsey mark IV operation.[?]Duodenal stenosis:Duodenal atresia is the congenital septum of duodenal obstruction at the commencement of the third part of the duodenum.Repaired by duodenoduodenostomy.
Hiatus hernia
Achalasia cardia
Gastro Oesophageal Reflux Disease
Duodenal stenosis
Oesophagus