Does Concomitant Anterior Fundoplication Promote Dysphagia after Laparoscopic Heller Myotomy?

2008 ◽  
Vol 74 (7) ◽  
pp. 626-634 ◽  
Author(s):  
Donovan Tapper ◽  
Connor Morton ◽  
Emily Kraemer ◽  
Desiree Villadolid ◽  
Sharona B. Ross ◽  
...  
Keyword(s):  
Chest Pain ◽  
Gastroesophageal Reflux ◽  
Randomized Trial ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Matched Pairs ◽  
Severe Dysphagia ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Anterior Fundoplication

Concerns for gastroesophageal reflux after laparoscopic Heller myotomy for achalasia justify considerations of concomitant anterior fundoplication. This study was undertaken to determine if concomitant anterior fundoplication reduces symptoms of reflux after myotomy without promoting dysphagia. From 1992 to 2004, 182 patients underwent laparoscopic Heller myotomy without fundoplication. After a prospective randomized trial justified its concomitant application, anterior fundoplication was undertaken with laparoscopic Heller myotomy in 171 patients from 2004 to 2007. All patients have been prospectively followed. Pre and postoperatively, patients scored the frequency and severity of symptoms of achalasia (including dysphagia, choking, vomiting, regurgitation, chest pain, and heartburn) using a Likert Scale (0 = never/not bothersome to 10 = always/very bothersome). Before myotomy, symptoms of achalasia were frequent and severe for all patients. After myotomy, the frequency and severity of all symptoms of achalasia significantly decreased for all patients ( P < 0.001, Wilcoxon matched pairs test). Notably, relative to patients undergoing laparoscopic Heller myotomy alone, concomitant anterior fundoplication led to significantly less frequent and severe heartburn after myotomy ( P < 0.05, Mann-Whitney Test) and to less frequent and severe dysphagia and choking ( P < 0.05, Mann-Whitney Test). Laparoscopic Heller myotomy reduces the frequency and severity of symptoms of achalasia. Concomitant anterior fundoplication decreases the frequency and severity of heartburn and dysphagia after laparoscopic Heller myotomy. Concomitant anterior fundoplication promotes salutary relief in the frequency and severity of symptoms after myotomy and is warranted.

Laparoscopic Heller Myotomy and Fundoplication in Patients with Chagas’ Disease Achalasia and Massively Dilated Esophagus

2013 ◽  
Vol 79 (1) ◽  
pp. 72-75 ◽  
Author(s):  
Carlos A. R. Pantanali ◽  
Fernando A. M. Herbella ◽  
Maria A. Henry ◽  
Jose Francisco Mattos Farah ◽  
Marco G. Patti
Keyword(s):  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
The Other ◽  
Esophageal Dilatation ◽  
Severe Dysphagia ◽  
Anterior Fundoplication ◽  
Laparoscopic Esophagectomy ◽  
End Stage

Laparoscopic Heller myotomy and fundoplication is considered today the treatment of choice for achalasia. The optimal treatment for end-stage achalasia with esophageal dilation is still controversial. This multicenter and retrospective study aims to evaluate the outcome of laparoscopic Heller myotomy in patients with a massively dilated esophagus. Eleven patients (mean age, 56 years; 6 men) with massively dilated esophagus (esophageal diameter greater than 10 cm) underwent a laparoscopic Heller myotomy and anterior fundoplication between 2000 and 2009 at three different institutions. Preoperative workup included upper endoscopy, esophagram, and esophageal manometry in all patients. Average follow-up was 31.5 months (range, 3 to 60 months). Two patients (18%) had severe dysphagia, four patients (36%) had mild and occasional dysphagia to solid food, and five patients (45%) were asymptomatic. All patients gained or kept body weight, except for the two patients with severe dysphagia. Of the two patients with severe dysphagia, one underwent esophageal dilatation and the other a laparoscopic esophagectomy. They are both doing well. Heller myotomy relieves dysphagia in the majority of patients even when the esophagus is massively dilated.

Laparoscopic Heller Myotomy with Anterior Fundoplication Improves Frequency and Severity of Symptoms of Achalasia, Regardless of Preoperative Severity Determined by Esophagography

2018 ◽  
Vol 84 (2) ◽  
pp. 165-173 ◽  
Author(s):  
Alexander Rosemurgy ◽  
Darrell Downs ◽  
Kenneth Luberice ◽  
Christian Rodriguez ◽  
Forat Swaid ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Chest Pain ◽  
Linear Regression ◽  
Heller Myotomy ◽  
Linear Regression Analysis ◽  
Gastroesophageal Junction ◽  
Laparoscopic Heller Myotomy ◽  
Anterior Fundoplication ◽  
Barium Esophagogram ◽  
Patients Experience

This study was undertaken to determine whether postoperative outcomes after laparoscopic Heller myotomy with anterior fundoplication could be predicted by preoperative findings on esophagography. Preoperative barium esophagograms of 135 patients undergoing laparoscopic Heller myotomy with anterior fundoplication were reviewed. The number of esophageal curves, esophageal width, and angulation of the gastroesophageal junction (GEJ) were determined; correlations between these determined parameters and symptoms were assessed using linear regression analysis. The number of esophageal curves correlated with the preoperative frequency of dysphagia, vomiting, chest pain, regurgitation, and heartburn. The width of the esophagus negatively correlated with the preoperative frequency of regurgitation. The angulation of the GEJ did not correlate with preoperative symptoms. Laparoscopic Heller myotomy with anterior fundoplication significantly reduced the frequency and severity of all symptoms, regardless of the number of esophageal curves, esophageal width, or angulation of the GEJ. Laparoscopic Heller myotomy with anterior fundoplication provides dramatic palliation for achalasia. More esophageal curves on preoperative esophagography correlate well with the frequency of a broad range of preoperative symptoms, including the frequency of dysphagia and regurgitation. Patients experience dramatically improved frequency and severity of symptoms after laparoscopic Heller myotomy with anterior fundoplication for achalasia regardless of the number of esophageal curves, esophageal width, or the angulation of the GEJ. Findings on barium esophagogram, in evaluating achalasia, should not deter the application of laparosocopic Heller myotomy with anterior fundoplication.

Therapeutic Effects of a Laparoscopic Heller Myotomy and Dor Fundoplication on the Chest Pain Associated with Achalasia

Surgery Today ◽  
2006 ◽  
Vol 36 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Nobuo Omura ◽  
Hideyuki Kashiwagi ◽  
Kazuto Tsuboi ◽  
Yoshio Ishibashi ◽  
Naruo Kawasaki ◽  
...  
Keyword(s):  
Chest Pain ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Therapeutic Effects ◽  
Dor Fundoplication

Prevalence of gastroesophageal reflux after laparoscopic Heller myotomy

1999 ◽  
Vol 13 (10) ◽  
pp. 1010-1014 ◽  
Author(s):  
W. O. Richards ◽  
R. H. Clements ◽  
P. C. Wang ◽  
C. D. Lind ◽  
H. Mertz ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy

scholarly journals PERORAL (POEM) OR SURGICAL MYOTOMY FOR THE TREATMENT OF ACHALASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 57 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Rafael Krieger MARTINS ◽  
Igor Braga RIBEIRO ◽  
Diogo Turiani Hourneaux DE MOURA ◽  
Kelly E HATHORN ◽  
Wanderley Marques BERNARDO ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastroesophageal Reflux ◽  
Adverse Events ◽  
Heller Myotomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Laparoscopic Heller Myotomy ◽  
Eckardt Score ◽  
Post Procedure

ABSTRACT BACKGROUND: Achalasia is a neurodegenerative motility esophageal disorder characterized by failure of lower esophageal sphincter relaxation. The conventional treatment option for achalasia has been laparoscopic Heller myotomy (LHM). However, in 2010, Inoue et al. described peroral endoscopic myotomy (POEM), a minimally invasive procedure, as an alternative therapy. To date, some studies with small sample sizes have aimed to compare outcomes of LHM vs POEM. OBJECTIVE: Thus, the aim of this study is to perform a systematic review and meta-analysis to better evaluate the efficacy and safety of these two techniques. METHODS: Individualized search strategies were developed from inception through April 2019 in accordance with PRISMA guidelines. Variables analyzed included operative time, overall adverse events rate, post-procedure gastroesophageal reflux disease (GERD), hospitalization length, post-procedure pain score, and Eckardt Score reduction. RESULTS: Twelve cohort trials were selected, consisting of 893 patients (359 in POEM group and 534 in LHM.) No randomized clinical trials were available. There was no difference in operative time (MD= -10,26, 95% CI (-5,6 to 8,2), P<0.001) or Post-Operative Gastroesophageal Reflux (RD: -0.00, 95%CI: (-0.09, 0.09), I2: 0%). There was decreased length of hospital stay for POEM (MD: -0.6, 95% CI (-1.11, -0.09), P=0.02), and an increased mean reduction in Eckardt score in POEM patients (MD = -0.257, 95% CI: (-0.512 to -0.002), P=0.048), with similar rates of adverse events. CONCLUSION: POEM demonstrated similar results compared to laparoscopic Heller myotomy with regards to improvement of dysphagia, post-procedure reflux, and surgical time, with the benefit of shorter length of hospital stay. Therefore, POEM can be considered an option for patients with achalasia.

Dor Versus Toupet Fundoplication after Laparoscopic Heller Myotomy: Report from a 2 Years Randomized Trial Evaluated by High Resolution Manometry

2017 ◽  
Vol 152 (5) ◽  
pp. S1208
Author(s):  
Blanca A. Blancas Breña ◽  
Gonzalo Torres-Villalobos ◽  
Fernanda Romero-Hernández ◽  
Axel R. Palacios Ramirez ◽  
Enrique Coss-Adame ◽  
...  
Keyword(s):  
High Resolution ◽  
Randomized Trial ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Toupet Fundoplication ◽  
High Resolution Manometry
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