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. 2011 Aug 7;17(29):3431-40.
doi: 10.3748/wjg.v17.i29.3431.

Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia

Natale Di Martino  1 , Antonio Brillantino, Luigi Monaco, Luigi Marano, Michele Schettino, Raffaele Porfidia, Giuseppe Izzo, Angelo Cosenza
Affiliations

Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia

Natale Di Martino et al. World J Gastroenterol. .

Abstract

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 Nissen-Rossetti 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-Whitney U-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) (P < 0.0001; Mann-Whitney U-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.

Keywords: Achalasia; Dor fundoplication; Dysphagia; Gastroesophageal reflux; Laparoscopy; Nissen-Rossetti fundoplication.

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Figures

Figure 1
Figure 1
Preoperative symptoms. Prevalence of dysphagia, regurgitation and heartburn in patients enrolled in the study.
Figure 2
Figure 2
Quality of life at 24 mo follow-up. Postoperative Qol (as measured by the SF-36 questionnaire) in patients with a partial anterior fundoplication and with a total fundoplication (P > 0.05; unpaired t-test).
Figure 3
Figure 3
Postoperative oesophageal manometry. Neo-sphinteric median resting pressure in patients with a Dor and with a Nissen-Rossetti fundoplication (P < 0.0001; Mann-Whitney U-test).
Figure 4
Figure 4
Oesophago-gastric pH monitoring at 24-mo follow-up. Median percentage of total time with oesophageal acid exposure in patients with partial and total fundoplication (P < 0.0001; Mann-Whitney U-test).
See this image and copyright information in PMC

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