ISSN 1308-8734 | E-ISSN 1308-8742
Original Article
Fundoplication After Heller Myotomy: A Retrospective Comparison Between Nissen and Dor
1 Unit of General Surgery 2nd and Thoracic Surgery IRCCS “Casa Sollievo della Sofferenza” Hospital - Viale Cappuccini 1 -71013 San Giovanni Rotondo, FG, Italy  
2 Unit of Gastroenterology, IRCCS “Casa Sollievo della Soff erenza” Hospital, Viale Cappuccini, San Giovanni Rotondo, FG, Italy  
3 Unit of Biostatistics, IRCCS “Casa Sollievo della Soff erenza” Hospital-Viale Cappuccini, San Giovanni Rotondo, FG, Italy  
4 Unit of General Surgery 2nd and Thoracic Surgery, IRCCS “Casa Sollievo della Soff erenza” Hospital, Viale Cappuccini, San Giovanni Rotondo, FG, Italy, Graduate School of Medicine, Catholic University of the Sacred Heart - Largo Francesco Vito, Rome, Italy  
Eurasian J Med 2011; 43: 133-140
DOI: 10.5152/eajm.2011.31
Key Words: Achalasia, Dysphagia, Fundoplication, Heller myotomy, Nissen-Dor comparison
Abstract

 

Objective: A retrospective comparison between Nissen and Dor fundoplication after laparoscopic Heller myotomy for achalasia.

Materials and Methods: From 1998 to 2004 a first group of 48 patients underwent Heller myotomy and Nissen fundoplication for idiopathic achalasia (H+N group). From 2004 to 2010 a second group of 40 patients underwent Heller myotomy followed by Dor fundoplication (H+D group). Some patients received a previous endoscopic treatment with pneumatic dilatation or endoscopic injection of botulinum toxin that provided them only a temporary clinical benefit. Changes in clinical and instrumental examinations from before to after surgery were evaluated in all patients. Clinical evaluation was carried out using a modified DeMeester symptom score system.

Results: Dor fundoplication treatment reduced both dysphagia and regurgitation severity scores significantly more than Nissen fundoplication (p<0.0001). Indeed, the incidence of dysphagia was significantly higher in patients treated with floppy-Nissen than in those treated with Dor fundoplication: by defining dysphagia as a DeMeester score equal to 3 (arbitrary cut-off), at the end of follow-up dysphagia occurred in 17.65% and 0% (p=0.037) of patients belonging to the H+N and H+D groups, respectively.

Conclusion: Heller myotomy followed by Dor fundoplication is a safe and valuable treatment. The procedure showed a lower incidence of postoperative dysphagia versus Nissen fundoplication and a negligible incidence of postoperative GERD in a long-term postoperative follow-up.

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