Meta-Analysis
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World J Gastroenterol. Nov 21, 2013; 19(43): 7804-7812
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7804
Is Dor fundoplication optimum after laparoscopic Heller myotomy for achalasia? A meta-analysis
Ming-Tian Wei, Ya-Zhou He, Xiang-Bing Deng, Yuan-Chuan Zhang, Ting-Han Yang, Cheng-Wu Jin, Bing Hu, Zi-Qiang Wang
Ming-Tian Wei, Ya-Zhou He, Xiang-Bing Deng, Yuan-Chuan Zhang, Ting-Han Yang, Cheng-Wu Jin, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Bing Hu, Endoscopic Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang ZQ and Wei MT designed the research; Wang ZQ and Hu B provided supervision; Wei MT, He YZ and Deng XB performed the research; Zhang YC, Yang TH and Jin CW performed a literature search and collected the data; Wei MT and He YZ analyzed the data and wrote the paper.
Supported by National Natural Science Foundation of China, Grant 81172373
Correspondence to: Zi-Qiang Wang, Professor, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China. wangzqzyh@163.com
Telephone: +86-28-85422480 Fax: +86-28-81654035
Received: July 14, 2013
Revised: August 24, 2013
Accepted: September 16, 2013
Published online: November 21, 2013
Abstract

AIM: To compare the outcome of acid reflux prevention by Dor fundoplication after laparoscopic Heller myotomy (LHM) for achalasia.

METHODS: Electronic database PubMed, Ovid (Evidence-Based Medicine Reviews, EmBase and Ovid MEDLINE) and Cochrane Library were searched between January 1995 and September 2012. Bibliographic citation management software (EndNote X3) was used for extracted literature management. Quality assessment of random controlled studies (RCTs) and non-RCTs was performed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and a modification of the Newcastle-Ottawa Scale, respectively. The data were analyzed using Review Manager (Version 5.1), and sensitivity analysis was performed by sequentially omitting each study.

RESULTS: Finally, 6 studies, including a total of 523 achalasia patients, compared Dor fundoplication with other types of fundoplication after LHM (Dor-other group), and 8 studies, including a total of 528 achalasia patients, compared Dor fundoplication with no fundoplication after LHM (Dor-no group). Dor fundoplication was associated with a significantly higher recurrence rate of clinical regurgitation and pathological acid reflux compared with the other fundoplication group (OR = 7.16, 95%CI: 1.25-40.93, P = 0.03, and OR = 3.79, 95%CI: 1.23-11.72, P = 0.02, respectively). In addition, there were no significant differences between Dor fundoplication and no fundoplication in all subjects. Other outcomes, including complications, dysphagia, postoperative physiologic testing, and operation-related data displayed no significant differences in the two comparison groups.

CONCLUSION: Dor fundoplication is not the optimum procedure after LHM for achalasia. We suggest more attention should be paid on quality of life among different fundoplications.

Keywords: Laparoscopic Heller myotomy, Dor fundoplication, Gastroesophageal reflux, Achalasia, Meta-analysis

Core tip: Laparoscopic Heller myotomy (LHM) is commonly used to treat achalasia and an antireflux procedure is added after LHM for prevention of gastroesophageal reflux (GER). However, there is no consensus on whether Dor fundoplication is the optimum procedure after LHM for the prevention of GER. We conducted this meta-analysis to assess Dor fundoplication compared with non-fundoplication surgery or other types of fundoplication surgery for achalasia. The results indicated higher recurrence rate of clinical regurgitation and pathological acid reflux in Dor fundoplication indicating that Dor fundoplication is not the optimum procedure for the prevention of GER after LHM in achalasia patients.