Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia
AIM：To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS：Fifty-six patients（26 men,30 women;mean age 42.8±14.7 years）presenting for minimally invasive surgery for oesophagea...
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| Published in: | World journal of gastroenterology : WJG Vol. 17; no. 29; pp. 3431 - 3440 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Baishideng Publishing Group Co., Limited
07-08-2011
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | AIM：To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS：Fifty-six patients（26 men,30 women;mean age 42.8±14.7 years）presenting for minimally invasive surgery for oesophageal achalasia,were enrolled.All patients underwent laparoscopic Heller myotomy followed by a 180°anterior partial fundoplication in 30 cases（group 1）and calibrated NissenRossetti fundoplication in 26（group 2）.Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication.A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken.One and two years after surgery,the patients underwent symptom questionnaires,endoscopy,oesophageal manometry and 24 h oesophago-gastric pH monitoring.RESULTS：At the 2-year follow-up,no significant difference in the median symptom score was observed between the 2 groups（P=0.66;Mann-WhitneyU-test）.The median percentage time with oesophageal pH 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group（2;range 0.8-10 vs 0.35;range 0-2）（P0.0001;Mann-WhitneyU-test）.CONCLUSION：Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia.Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure. |
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| Bibliography: | Natale Di Martino,Antonio Brillantino,Luigi Monaco,Luigi Marano,Michele Schettino,Raffaele Porfidia,Giuseppe Izzo,Angelo Cosenza（VIII Department of General and Gastrointestinal Surgery,School of Medicine,Second University of Naples,Piazza Miraglia 2,80138 Naples,Italy ） 14-1219/R AIM：To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS：Fifty-six patients（26 men,30 women;mean age 42.8±14.7 years）presenting for minimally invasive surgery for oesophageal achalasia,were enrolled.All patients underwent laparoscopic Heller myotomy followed by a 180°anterior partial fundoplication in 30 cases（group 1）and calibrated NissenRossetti fundoplication in 26（group 2）.Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication.A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken.One and two years after surgery,the patients underwent symptom questionnaires,endoscopy,oesophageal manometry and 24 h oesophago-gastric pH monitoring.RESULTS：At the 2-year follow-up,no significant difference in the median symptom score was observed between the 2 groups（P=0.66;Mann-WhitneyU-test）.The median percentage time with oesophageal pH 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group（2;range 0.8-10 vs 0.35;range 0-2）（P0.0001;Mann-WhitneyU-test）.CONCLUSION：Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia.Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure. Achalasia; Dor fundoplication; Dysphagia; Gastroesophageal reflux; Laparoscopy; Nissen-Rossetti fundoplication ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Author contributions: Di Martino N conceived the study, its design and coordination; Brillantino A drafted the manuscript and carried out the diagnostic tests and statistical analysis; Monaco L and Schettino M carried out the symptom questionnaires and patient follow-up; Porfidia R and Marano L performed the data collection and analysis; Izzo G and Cosenza A were involved in the patients’ management, study design and its revision; all authors read and approved the final manuscript. Telephone: +39-81-5665058 Fax: +39-81-5665055 Correspondence to: Antonio Brillantino, MD, VIII Department of General and Gastrointestinal Surgery, School of Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy. antonio.brillantino@email.it |
| ISSN: | 1007-9327 2219-2840 |
| DOI: | 10.3748/wjg.v17.i29.3431 |