Laparoscopic Heller myotomy and anterior Dor fundoplication for achalasia cardia in Malaysia: Clinical outcomes and satisfaction from four tertiary centers

Siow, Sze Li; Mahendran, Hans Alexander; Najmi, Wan Daud; Lim, Shyang Yee; Hashimah, A R; Voon, Kelvin; Teoh, Keat How; Boo, Han Sin; Chuah, Jun Sen; Sidi, Nurazim; Faqihuddin, Bin Hisham

doi:10.1016/j.asjsur.2020.04.007

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…In patients with achalasia, where esophageal peristalsis is absent/impaired, partial fundoplication may be more suitable than total fundoplication to reduce the incidence of postoperative dysphagia 84,85 . The anterior Dor and posterior Toupet anti‐reflux procedures are the most common fundoplication procedures performed in the Asia–Pacific region 86 . There have been multiple randomized trials and meta‐analyses showing comparable outcomes with both approaches with both procedures having effective control of GERD and minimal incidence of dysphagia 87–89 …”

Section: Resultsmentioning

confidence: 99%

“…84,85 The anterior Dor and posterior Toupet anti-reflux procedures are the most common fundoplication procedures performed in the Asia-Pacific region. 86 There have been multiple randomized trials and meta-analyses showing comparable outcomes with both approaches with both procedures having effective control of GERD and minimal incidence of dysphagia. [87][88][89] Statement 16: Consider esophagectomy if all options have failed, refractory symptoms, or end-stage achalasia…”

Section: Statement 15: Fundoplication In Combination With Hm Is Recom...mentioning

confidence: 99%

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Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Chuah,

Ramasami,

Mahendran

et al. 2023

J of Gastro and Hepatol

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Disorders of esophagogastric junction (EGJ) outflow, including achalasia and EGJ outflow obstruction, are motility disorders characterized by inadequate relaxation of lower esophageal sphincter with or without impaired esophageal peristalsis. Current guidelines are technical and less practical in the Asia–Pacific region, and there are still massive challenges in timely diagnosis and managing these disorders effectively. Therefore, a Malaysian joint societies' task force has developed a consensus on disorders of EGJ outflow based on the latest evidence, while taking into consideration the practical relevance of local and regional context and resources. Twenty‐one statements were established after a series of meetings and extensive review of literatures. The Delphi method was used in the consensus voting process. This consensus focuses on the definition, diagnostic investigations, the aims of treatment outcome, non‐surgical or surgical treatment options, management of treatment failure or relapse, and the management of complications. This consensus advocates the use of high‐resolution esophageal manometry for diagnosis of disorders of EGJ outflow. Myotomy, via either endoscopy or laparoscopy, is the preferred treatment option, while pneumatic dilatation can serve as a secondary option. Evaluation and management of complications including post‐procedural reflux and cancer surveillance are recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Statement 15: Fundoplication In Combination With Hm Is Recom...mentioning

confidence: 99%

Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Chuah,

Ramasami,

Mahendran

et al. 2023

J of Gastro and Hepatol

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“…The surgeons in this study were more familiar with Nissen and believed that its antireflux effect would be greater than that of other types of antireflux surgery. Recent trends shifted from Nissen to Dor or Toupet fundoplication, which might be the better surgical approach for GERD with less postoperative complications such as dysphagia, bloating, and equal effectiveness as Nissen 57 – 59 . Third, participants in this study were young and well-improved by PPI medications.…”

Section: Discussionmentioning

confidence: 99%

Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication

Park

Kim

et al. 2023

International Journal of Surgery

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Background: Currently, the reported parameters that predict the resolution of symptoms after surgery are largely subjective and unreliable. Considering that fundoplication rebuilds the structural integrity of the lower esophageal sphincter (LES), the authors focused on searching for objective and quantitative predictors for the resolution of symptoms based on the anatomical issues and whether an antireflux barrier can be well established or not. Materials and methods: The authors reviewed the prospectively collected data of 266 patients with gastroesophageal reflux disease (GERD) who had undergone laparoscopic Nissen fundoplication (LNF). All patients were diagnosed with GERD using preoperative esophagogastroduodenoscopy, 24-h ambulatory esophageal pH monitoring, and high-resolution esophageal manometry. The patients received GERD symptom surveys using the validated Korean Antireflux Surgery Group questionnaire twice: preoperatively and 3 months after the surgery. Results: After excluding patients with insufficient follow-up data, 152 patients were included in the analysis. Multivariate logistic regression analyses revealed that a longer length of the LES and lower BMI determined better resolution of typical symptoms after LNF (all P<0.05). Regarding atypical symptoms, higher resting pressure of LES and DeMeester score greater than or equal to 14.7 were associated with better resolution after the surgery (all P<0.05). After LNF, typical symptoms improved in 34 out of 37 patients (91.9%) with a length of LES >greater than .05 cm, BMI less than 23.67 kg/m2, and atypical symptoms were resolved in 16 out of 19 patients (84.2%) with resting pressure of LES greater than or equal to 19.65 mm Hg, DeMeester score greater than or equal to 14.7. Conclusion: These results show that the preoperative length and resting pressure of LES is important in the objective prediction of symptom improvement after LNF.

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“…Many authors routinely place NGT after this surgery, others insert it before, but they say nothing about its removal [54][55][56]. However, it is not clear if other authors use it [57][58][59][60][61][62][63]. Our study attempted to answer this question in consecutive achalasia patients treated with LHD.…”

Section: Discussionmentioning

confidence: 99%

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

Palomba

Basile

Capuano

et al. 2023

Preprint

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Background Achalasia is a rare esophageal motor disorder. Laparoscopic Heller-Dor myotomy (LHD) is among the most effective treatments. The use of nasogastric tube (NGT) following LHD is still controversial. The aim of our study was to evaluate the role of NGT in achalasia patients undergoing LHD. Methods We prospectively enrolled achalasia patients treated with LHD from January 2019 until June 2022 at our institution and randomly assigned them to two groups: one group with NGT and group without (noNGT). Perioperative outcomes were compared between the two groups. ClinicalTrials.gov Identifier: NCT05729971. Results Seventy-nine patients who underwent LHD myotomy were prospectively enrolled. Patients were divided in two groups: 38 with NGT and 41 noNGT. There were no significant differences between two groups in terms of demographic data, preoperative characteristics, length of stay, start of liquid and solid diet, intraoperative and postoperative complications. First flatus was shorter in the noNGT group (p: 0.03). Conclusion Nasogastric tube placement following LHD myotomy does not reduce nausea, vomiting and chest pain, while it increased patients discomfort and time of first flatus.

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Laparoscopic Heller myotomy and anterior Dor fundoplication for achalasia cardia in Malaysia: Clinical outcomes and satisfaction from four tertiary centers

Cited by 7 publications

References 32 publications

Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

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