Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia

Richardson, W. S., Kennedy, C. I. and Bolton, J. S. (2006) Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia. Surgical Endoscopy, 20 12: 1914-1918. doi:10.1007/s00464-006-0227-9


Author Richardson, W. S.
Kennedy, C. I.
Bolton, J. S.
Title Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia
Journal name Surgical Endoscopy   Check publisher's open access policy
ISSN 0930-2794
1432-2218
Publication date 2006-12
Sub-type Article (original research)
DOI 10.1007/s00464-006-0227-9
Volume 20
Issue 12
Start page 1914
End page 1918
Total pages 5
Place of publication Secaucus, NJ, United States
Language eng
Formatted abstract
Background: This study aimed to compare the outcomes for Heller myotomy alone and combined with different partial fundoplications.
Methods: The authors retrospectively reviewed their experience with 69 laparoscopic myotomies and 14 Heller myotomies, 80% of which were performed with partial fundoplication including 20 Toupet, 18 Dor, and 17 modified Dor procedures, in which the fundoplication is sutured to both sides of the crura and not the myotomy.
Results: The mean age of the study patients was 69 years (range, 15–80 years). Four mucosal perforations were repaired intraoperatively. There was one small bowel fistula in an area of open hernia repair distant from the myotomy. One patient with severe chronic obstructive pulmonary disease died of pneumonia. Phone follow-up evaluation was achieved in 68% of the cases at a mean of 37 months (range, 2–97 months). The results for no dysphagia and for heartburn requiring proton pump inhibitors, respectively, were as follows: Heller myotomy (85.7%, 28.5%), Toupet (66.6%, 33.3%), Dor (83.3%, 20%), and modified Dor (84.6%, 15.3%). Two patients with reflux strictures required annual dilation (Toupet, Dor). Two patients required revisions: one redo Heller myotomy (Dor) and one esophageal replacement (Toupet).
Conclusion: Heller myotomy provides excellent dysphagia relief with or without fundoplication. Heartburn is a significant problem for a minority of patients. In the authors’ hands, Toupet had the worst results and modified Dor was most protective for heartburn.
Keyword Achalasia
Balloon dilation
Botulinum toxin
Fundoplication
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 7 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 14 Mar 2011, 10:51:50 EST