Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia

Abstract

For the treatment of achalasia, EM with Toupet fundoplication provides excellent durable dysphagia relief that is superior to SM with Dor fundoplication.

The therapeutic results after laparoscopic hellers’ myotomy and partial fundoplication for achalasia

“…There are no published data comparing both. Some surgeons prefer a posterior approach as it keeps the edges of the myotomy separated and it may be more effective for antireflux operation while others prefer an anterior method and say it is easier to perform without the need of posterior dissection and it adds the advantage of covering the exposed mucosa (3,(7)(8)(9)(10). In our study group we mostly preferred to perform a Laparoscopic Heller myotomy with Toupet fundoplication (34 patients) as it is suggested in many reports (10).…”

Laparoscopy as the initial approach for epiphrenic diverticula

“…Furthermore, the vast majority (86%) rated the operation as successful. We credit the good results to our adherence to the surgical principles of complete diverticulum resection, relief of distal obstruction with a myotomy, and when possible, mitigate the risk of gastroesophageal reflux with a 270-degree posterior fundoplication [21]. No studies have compared the long-term outcomes in patients operated from the chest and the abdomen for epiphrenic diverticula.…”

Recent Trends in the Management of Achalasia

“…They found that extended myotomy provides excellent dysphagia relief, superior to that obtained with standard myotomy. 25) Patti et al reported that impaired visualization of the gastroesophageal junction might be the principal cause of an inadequate cardiomyotomy. 26) Available evidence thus indicates that evaluation of the anterior esophageal fat pad to accurately identify the gastroesophageal junction and a cut length of at least 2 cm in cardiomyotomy are the most important determinants of a successful outcome of Heller myotomy (Fig.…”