Heller's operation done for -

Ans. is 'c' i.e., Achalasia cardia Treatment of Achalasiao The aim of treatment is to be relieve the functional obstruction at the cardiao The two main methods to achieve this are:1. Forceful dilatation or2. Esophageal myotomy (Heller's myotomy) with or without an antireflux procedure.1)Forceful dilatation (pneumatic dilatation)The aim is to weaken or rupture the circular muscle fibres of the LES by forceful stretch.Perforation and bleeding are potential complications.2)Extram ucosal cardiomyotomy (Heller \ myotomy)This involves surgical division of the muscle fibres of the lower esophageal sphincter.This procedure can be performed through a laparoscopic or thoracoscopic approach (Open surgical procedure i.e. Laparotomy or thoractomy can also be done, but the videoscopic procedure is better).Major complication is gastro-esophageal reflux.Partial fundoplication is done to prevent reflux.''Modified laparoscopic Heller myotomy is the operation of choice " ____SabistonOther methods of treatmentDrugso Nitrates and calcium channel bockers can be used, but are ineffective for long term use. They can be used for transient relief of symptoms,o Botulinum toxino Botulinum toxin is given by endoscopic injection into the LES. It reduces LES pressure by blocking the cholinergic excitatory nerves in the sphinctero Its effect is only short-lived and repeated injections have to be give.o Used only in patients unfit for surgery and pneumatic dilatation.