2004/08/19 by William O. Richards, Alfonso Torquati, Michael D. Holzman +5 · 27 citations
Medicine · #Gastroesophageal reflux and treatments #Bariatric Surgery and Outcomes #Esophageal and GI Pathology
paper · doi:10.1097/01.sla.0000136940.32255.51
In Brief Objective: We sought to determine the impact of the addition of Dor fundoplication on the incidence of postoperative gastroesophageal reflux (GER) after Heller myotomy. Summary Background Data: Based only on case series, many surgeons believe that an antireflux procedure should be added to the Heller myotomy. However, no prospective randomized data support this approach. Patients and Methods: In this prospective, randomized, double-blind, institutional review board-approved clinical trial, patients with achalasia were assigned to undergo Heller myotomy or Heller myotomy plus Dor fundoplication. Patients were studied via 24-hour pH study and manometry at 6 months postoperatively. Pathologic GER was defined as distal esophageal time acid exposure time greater than 4.2% per 24-hour period. The outcome variables were analyzed on an intention-to-treat basis. Results: Forty-three patients were enrolled. There were no differences in the baseline characteristics between study groups. Pathologic GER occurred in 10 of 21 patients (47.6%) after Heller and in 2 of 22 patients (9.1%) after Heller plus Dor (P = 0.005). Heller plus Dor was associated with a significant reduction in the risk of GER (relative risk 0.11; 95% confidence interval 0.02–0.59; P = 0.01). Median distal esophageal acid exposure time was lower in the Heller plus Dor (0.4%; range, 0–16.7) compared with the Heller group (4.9%; range, 0.1–43.6; P = 0.001). No significant difference in surgical outcome between the 2 techniques with respect to postoperative lower-esophageal sphincter pressure or postoperative dysphagia score was observed. Conclusions: Heller Myotomy plus Dor Fundoplication was superior to Heller myotomy alone in regard to the incidence of postoperative GER. A prospective, randomized, double-blind, study was performed to determine the impact of Dor fundoplication on the incidence of gastroesophageal reflux (GER) after Heller myotomy. Patients were studied using 24-hour pH study. Pathologic GER occurred in 10 patients (47.6%) after Heller alone (n = 21) and in 2 patients (9.1%) after Heller plus Dor (n = 22).