TECAD Cirurgia Digestiva Practice Questions - TECAD - Título De Especialista Em Cirurgia Do Aparelho Digestivo (CBCD AMB) Exam

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A 52-year-old man from Goiás, Brazil, presents with progressive dysphagia to both solids and liquids for 8 years, nocturnal regurgitation, and a 12 kg weight loss. Serology for Trypanosoma cruzi (Chagas disease) is positive. A timed barium esophagogram reveals an esophageal diameter of 5.5 cm, marked retention of contrast with a distal 'bird's beak' taper, and uncoordinated non-propulsive tertiary contractions (Rezende Classification Group II / Grau II). Upper endoscopy rules out mucosal malignancy. According to the Brazilian consensus and CBCD guidelines for Chagasic megaesophagus (Megaesôfago Chagásico), what is the most appropriate surgical treatment?

Laparoscopic Heller cardiomyotomy extended 6 cm on the esophagus and 2 cm onto the stomach, combined with a partial anterior fundoplication (Heller-Pinotti procedure) Transhiatal subtotal esophagectomy with cervical esophagogastrostomy Serra-Dória procedure (cardioplasty with Roux-en-Y partial gastrectomy) Endoscopic balloon dilation with botulinum toxin injection into the lower esophageal sphincter as definitive therapy

Correct Answer:

Laparoscopic Heller cardiomyotomy extended 6 cm on the esophagus and 2 cm onto the stomach, combined with a partial anterior fundoplication (Heller-Pinotti procedure)

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