What is a Heller myotomy?

• A. A surgical myotomy of the distal esophageal sphincter to relieve obstruction in achalasia, often performed laparoscopically.
• B. Balloon dilation of the LES.
• C. Endoscopic clipping of Zenker's diverticulum.
• D. Gastric bypass.

Answer: (A)

Heller myotomy is a surgical procedure that relieves obstruction at the distal esophageal sphincter by cutting the circular muscle fibers of the lower esophagus and LES, reducing the sphincter’s resting pressure to allow food to pass into the stomach. It’s most often done laparoscopically and is sometimes extended a few centimeters onto the stomach, with a partial fundoplication added in many cases to prevent reflux after the LES is divided. This approach directly addresses the functional blockage seen in achalasia, unlike balloon dilation, which stretches the LES without cutting muscle. It’s also not the procedure used for Zenker’s diverticulum, and it’s unrelated to gastric bypass.