Randomized Controlled Trial of Laparoscopic Heller Myotomy Plus Dor Fundoplication Versus Nissen Fundoplication for Achalasia Long-Term Results

被引:177
|
作者
Rebecchi, Fabrizio [1 ]
Giaccone, Claudio [1 ]
Farinella, Eleonora [1 ]
Campaci, Roberto [1 ]
Morino, Mario [1 ]
机构
[1] Univ Turin, Dept Surg, Ctr Minimal Invas Surg, I-10126 Turin, Italy
关键词
D O I
10.1097/SLA.0b013e318190a776
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objectives: To compare in a prospective, randomized trial the long-term results of laparoscopic Heller myotomy plus Dor fundoplication versus laparoscopic Heller rnyotomy plus floppy-Nissen for achalasia. Summary Background Data: Anterior fundoplication is usually performed after Helier rnyotomy to control GER; however, the incidence of postoperative GER ranges between 10% and 30%. Total fundoplication may aid in reducing GER rates. Methods: From December 1993 to September 2002, 153 patients with achalasia underwent Heller laparoscopic myotomy plus antireflux fundoplication. Of these, 9 were excluded from the study. The remaining 144 patients were randomly assigned to 2 treatment groups: Heller laparoscopic rnyotomy plus anterior fundoplication (Dor procedure) or Heller laparoscopic rnyotomy Plus total fundoplication (floppy-Nissen procedure). The primary end point was incidence of clinical and instrumental GER after a minimum of 60 months follow-up. The secondary end point was recurrence of dysphagia. Follow-up clinical assessments were performed at 1, 3, 12, and 60 months using a modified DeMeester Symptom Scoring System (MDSS). Esophageal manometry and 24-hour pH monitoring were performed at 3, 12, and 60 months postoperative. Results: Of the 144 patients originally included in the study, 138 were available for long-term analysis: 71 (51%) underwent antireflux fundoplication plus a Dor procedure (H + D group) and 67 (49%) antireflux fundoplication Plus a Nissen procedure (H + N group). No mortality was observed. The mean follow-up period was 125 months. No statistically significant differences in clinical (5.6% vs. 0%) or instrumental GER (2.8% vs. 0%) were found between the 2 groups; however, a statistically significant difference in dysphagia rates was noted (2.8% vs, 15%; P < 0.001). Conclusions: Although both techniques achieved long-term GER control, the recurrence rate of dysphagia was significantly higher among the patients who underwent Nissen fundoplication. This evidence supports the use of Dor fundoplication as the preferred method to re-establish GER control in patients undergoing laparoscopic Heller myotomy.
引用
收藏
页码:1023 / 1030
页数:8
相关论文
共 50 条
  • [21] Laparoscopic Heller myotomy and Dor fundoplication for achalasia - Analysis of successes and failures
    Patti, MG
    Molena, D
    Fisichella, PM
    Whang, K
    Yamada, H
    Perretta, S
    Way, LW
    ARCHIVES OF SURGERY, 2001, 136 (08) : 870 - 875
  • [22] Esophageal Achalasia: From Laparoscopic to Robotic Heller Myotomy and Dor Fundoplication
    Arcerito, Massimo
    Jamal, Mazen
    Perez, Martin G.
    Kaur, Harpreet
    Sundahl, Andrew
    Moon, John T.
    JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS, 2022, 26 (03)
  • [23] A RANDOMIZED CONTROLLED TRIAL COMPARING PERORAL ENDOSCOPIC MYOTOMY (POEM) VERSUS LAPAROSCOPIC HELLER MYOTOMY WITH FUNDOPLICATION IN THE TREATMENT OF ACHALASIA
    Moura, Eduardo T.
    Farias, Galileu F.
    Coutinho, Lara M.
    Delgado, Aureo
    de Moura, Diogo T.
    Nasi, Ary
    Queiroz, Natalia S.
    Jayanthi, Shri K.
    Sallum, Rubens A.
    Cecconello, Ivan
    Sakai, Paulo
    de Moura, Eduardo G.
    GASTROINTESTINAL ENDOSCOPY, 2019, 89 (06) : AB84 - AB84
  • [24] DOES FUNDOPLICATION IMPROVE THE LONG-TERM RESULTS OF LAPAROSCOPIC HELLER MYOTOMY
    Costantino, Christina L.
    Geller, Abraham D.
    Visenio, Micheal R.
    Morse, Christopher R.
    Rattner, David W.
    GASTROENTEROLOGY, 2019, 156 (06) : S1372 - S1373
  • [25] Laparoscopic Heller myotomy and Dor fundoplication for achalasia - Analysis of successes and failures - Discussion
    Wolfe, BM
    Finley, RJ
    Bremner, CG
    Pellegrini, CA
    Debas, HT
    Patti
    ARCHIVES OF SURGERY, 2001, 136 (08) : 875 - 877
  • [26] Dor Vs Toupet Fundoplication After Laparoscopic Heller Myotomy: Long-Term Randomized Controlled Trial Evaluated by High-Resolution Manometry
    Torres-Villalobos, Gonzalo
    Coss-Adame, Enrique
    Furuzawa-Carballeda, Janette
    Romero-Hernandez, Fernanda
    Blancas-Brena, Blanca
    Torres-Landa, Samuel
    Palacios-Ramirez, Axel
    Alejandro-Medrano, Edgar
    Hernandez-Avila, Axel
    Flores-Najera, Athenea
    Avila Escobedo, Lourdes Margarita
    Ramirez Angulo, Cecilia
    Rodriguez-Garces, Angelica
    Angel Valdovinos, Miguel
    JOURNAL OF GASTROINTESTINAL SURGERY, 2018, 22 (01) : 13 - 22
  • [27] Dor Vs Toupet Fundoplication After Laparoscopic Heller Myotomy: Long-Term Randomized Controlled Trial Evaluated by High-Resolution Manometry
    Gonzalo Torres-Villalobos
    Enrique Coss-Adame
    Janette Furuzawa-Carballeda
    Fernanda Romero-Hernández
    Blanca Blancas-Breña
    Samuel Torres-Landa
    Axel Palacios-Ramírez
    Edgar Alejandro-Medrano
    Axel Hernández-Ávila
    Athenea Flores-Najera
    Lourdes Margarita Ávila Escobedo
    Cecilia Ramírez Angulo
    Angélica Rodríguez-Garcés
    Miguel Ángel Valdovinos
    Journal of Gastrointestinal Surgery, 2018, 22 : 13 - 22
  • [28] Laparoscopic Heller Myotomy and Dor Fundoplication for Esophageal Achalasia: Technique and Perioperative Management
    Andolfi, Ciro
    Fisichella, P. Marco
    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, 2016, 26 (11): : 916 - 920
  • [29] Heller myotomy vs Heller myotomy plus Dor fundoplication - Cost-utility analysis of a randomized trial
    Torquati, A
    Lutfi, R
    Khaitan, L
    Sharp, KW
    Richards, WO
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2006, 20 (03): : 389 - 393
  • [30] Laparoscopic Heller myotomy and fundoplication for achalasia - Discussion
    Polk, HC
    Richards, WO
    Meyers, WC
    Hunter, JG
    ANNALS OF SURGERY, 1997, 225 (06) : 664 - 665