Achalasia Cardia is a rare disorder that makes it difficult for food and liquid to pass from the swallowing tube connecting your mouth and stomach (esophagus) into your stomach. Achalasia Cardia occurs when nerves in the esophagus become damaged. As a result, the esophagus becomes paralyzed and dilated over time and eventually loses the ability to squeeze food down into the stomach. Food then collects in the esophagus, sometimes fermenting and washing back up into the mouth, which can taste bitter. Some people mistake this for gastroesophageal reflux disease (GERD). However, in achalasia the food is coming from the esophagus, whereas in GERD the material comes from the stomach. There's no cure for Achalasia Cardia. Once the esophagus is paralyzed, the muscle cannot work properly again. But symptoms can usually be managed with endoscopy, minimally invasive therapy or surgery.

1. ACHALASIA CARDIA
Management in a district level hospital, Bogura, Bangladesh
A video presentation

2. SURGEON AND THE TEAM
MEMBERS
• Associate professor Dr. Zakirul Alam(MBBS,FCPS,FMAS)
• DR. MD Moniruzzaman Monir(MBBS,FCPS-P1(Surgery))
• DR. MD Asif Nawas(MBBS)
• DR. Rafiqul Islam (MBBS, DA(Anesthesiology))
• Pronob Roy(OT boy)
• MST. Nasima (OT Sister).

3. CASE HISTORY
• MD Shariful Islam
• 20 years
• From Shirajgong, district
• Progressive dysphagia to solid and liquid diets for
3 years.
• Poor general health.

4. T0 BE CONTINUE….
• Repeated endoscopy done showing closed LES
• Ba-swallow showing dilated esophagus and “Bird’s beak”
appearance.
• Esophageal manometry advised but not done.
• Balloon dilatation performed 3 times having no sustainable
results.
• So Hellers Cardio-myotomy proposed.
• Laparoscopic Hellers Cardio-myotomy done successfully on
11.11.20 with DOR fundoplication at Doctors hospital,
Bogura.

5. STEPS OF OPERATION
• Mobilization of abdominal esophagus from the crus of diaphragm
• Mobilization of fundus of stomach cutting short gastric vessels.
• Esophageal myotomy done by using Harmonic scalpel extending up to
stomach.
• From the junction of angle of HIS-
• Esophagus-4cm
• Stomach-3cm
• Wrapping esophagus by gastric fundus anteriorly.
• After the surgical procedure, diet given on 2nd POD with no difficulty in
swallowing.
• patient discharged on 5th POD.