Is Dor fundoplication optimum after laparoscopic Heller myotomy for achalasia? A meta-analysis

Wei, Mingtian; He, Yazhou; Deng, Xiangbing; Zhang, Yuan-chuan; Yang, Tinghan; Jin, Chong; Hu, Bing; Wang, Ziqiang

doi:10.3748/wjg.v19.i43.7804

Cited by 27 publications

(13 citation statements)

References 27 publications

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“…This was performed in our patient and even at the 2-year follow-up no dysphagia or symptomatic GER was observed. This is in accordance with several studies that showed that 360 degree fundoplication is not an obstacle to esophageal emptying after laparoscopic Heller's myotomy [13], achieving excellent results in terms of dysphagia, while Nissen fundoplication seems superior to partial fundoplication in preventing postoperative esophageal acid exposure [14].…”

Section: Discussionsupporting

confidence: 92%

GERD: A Debated Background of Achalasia

Bognár¹,

Horváth²

2016

J Gastrointest Dig Syst

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Achalasia is a primary esophageal motility disorder of unknown etiology, characterized by aperistalsis of the esophageal body and impaired lower esophageal sphincter (LES) relaxation. Available data suggest that the disease is multifactorial, but the exact initiating factors that may play a role in the development of the disease remain unclear. Case presentation: We report the case of a 65 year-old woman who had typical reflux symptoms with heartburn and regurgitation for about seven years. During the year before her admission to our clinic her reflux symptoms resolved and dysphagia developed. Endoscopy revealed esophageal dilatation with erosive esophagitis, narrowed cardia and hiatal hernia. Barium swallow test, manometry and 24 hour pH monitoring confirmed the development of achalasia with accompanying gastroesophageal reflux disease (GERD). The patient underwent laparoscopic surgery, the hiatal hernia was reconstructed and a Heller's myotomy with a 360 degree Nissen fundoplication was performed. At the 3-year follow-up the patient was symptom free. Conclusion: Based on our experience and the review of the literature we believe that there is a cause-and-effect relationship between gastroesophageal reflux and the development of achalasia. In these cases a laparoscopic Heller's myotomy completed with a 360 degree Nissen fundoplication should be the recommended surgical treatment to minimize the possibility of postoperative reflux disease.

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Section: Discussionsupporting

confidence: 92%

GERD: A Debated Background of Achalasia

Bognár¹,

Horváth²

2016

J Gastrointest Dig Syst

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“…The fundoplication can be used to buttress (anterior/Dor fundoplication) or accentuate (posterior/ Toupet fundoplication) the myotomy, but is also thought [12][13][14]. Unfortunately, many studies demonstrate persistent reflux even in those patients who do have a fundoplication performed, including up to 21 % of patients following Toupet fundoplication and 42 % following a Dor fundoplication [15,16]. Peroral endoscopic myotomy does not include an anti-reflux procedure; thus, significant attention has been paid to the diagnosis, incidence, and management of reflux in order to better compare and contrast it with the gold standard.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy

et al. 2015

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“…It is worth pointing out that many studies have demonstrated a high incidence of GER when physiologic testing is performed in no antireflux procedure groups: Campos et al [ 1 ] in a systematic review and meta-analysis reported the rate of 41.5% for abnormal reflux when no fundoplication was added compared with 14.5% when one was performed ( p = 0.01); Falkenback et al [ 10 ] in their prospective randomized trial found that postoperative reflux was observed in 100% of the patients who had the myotomy alone vs. 25% of those who had myotomy with Nissen fundoplication; Richards et al [ 3 ] in their prospective randomized trial found that 48% of patients in the myotomy-alone group had abnormal GER postoperatively, while only 9% of patients had abnormal pH studies when myotomy and partial Dor fundoplication were performed. According to the published results, the routine application of fundoplication following laparoscopic Heller myotomy has been recommended as beneficial for protection against postoperative GER [ 1 , 11 ]. The type of fundoplication has been a subject of debate until now.…”

Section: Discussionmentioning

confidence: 99%

The choice of optimal antireflux procedure after laparoscopic cardiomyotomy: two decades of clinical experience in one center.

Kiudelis

Kubiliūtė

Šakalys

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionTwo types of partial wrap are commonly performed in achalasia patients after Heller myotomy: the posterior 270° fundoplication (Toupet) and the anterior 180° fundoplication (Dor). The optimal type of fundoplication (posterior vs. anterior) is still debated.AimTo compare the long-term rates of dysphagia, reflux symptoms and patient satisfaction with current postoperative condition between two fundoplication groups in achalasia treatment.Material and methodsOur retrospective study included 97 consecutive patients with achalasia: 37 patients underwent laparoscopic posterior Toupet (270°) fundoplication followed by Heller myotomy (group I); 60 patients underwent laparoscopic anterior partial Dor fundoplication followed by Heller myotomy (group II). Long-term follow-up results included evaluation of dysphagia symptoms, intensity of heartburn and patient satisfaction with current condition.ResultsPatients in these two groups did not differ according to age, weight, height, postoperative stay or follow-up period. Laparoscopic myotomy with posterior Toupet fundoplication was effective in 89% of patients, while laparoscopic myotomy with anterior Dor was effective in 93% of patients (p > 0.05). 11% of patients after posterior Toupet fundoplication had clinically significant heartburn vs. 35% of patients after anterior Dor fundoplication (p < 0.05). Overall patient satisfaction with current condition was 88%, with no significant difference between the groups.ConclusionsAccording to our study results, the two laparoscopic techniques were similarly effective in reducing achalasia symptoms, but postoperative clinical manifestation of heartburn is significantly more frequent after anterior Dor fundoplication (35% vs. 11%). The majority of patients (88%) were satisfied with operation outcomes.

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Is Dor fundoplication optimum after laparoscopic Heller myotomy for achalasia? A meta-analysis

Abstract: Dor fundoplication is not the optimum procedure after LHM for achalasia. We suggest more attention should be paid on quality of life among different fundoplications.

Cited by 27 publications

References 27 publications

GERD: A Debated Background of Achalasia

GERD: A Debated Background of Achalasia

Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy

The choice of optimal antireflux procedure after laparoscopic cardiomyotomy: two decades of clinical experience in one center.

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