Brief Article
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World J Gastroenterol. Aug 7, 2011; 17(29): 3431-3440
Published online Aug 7, 2011. doi: 10.3748/wjg.v17.i29.3431
Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia
Natale Di Martino, Antonio Brillantino, Luigi Monaco, Luigi Marano, Michele Schettino, Raffaele Porfidia, Giuseppe Izzo, Angelo Cosenza
Natale Di Martino, Antonio Brillantino, Luigi Monaco, Luigi Marano, Michele Schettino, Raffaele Porfidia, Giuseppe Izzo, Angelo Cosenza, VIII Department of General and Gastrointestinal Surgery, School of Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
Author contributions: Di Martino N conceived the study, its design and coordination; Brillantino A drafted the manuscript and carried out the diagnostic tests and statistical analysis; Monaco L and Schettino M carried out the symptom questionnaires and patient follow-up; Porfidia R and Marano L performed the data collection and analysis; Izzo G and Cosenza A were involved in the patients’ management, study design and its revision; all authors read and approved the final manuscript.
Correspondence to: Antonio Brillantino, MD, VIII Department of General and Gastrointestinal Surgery, School of Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy. antonio.brillantino@email.it
Telephone: +39-81-5665058 Fax: +39-81-5665055
Received: November 22, 2010
Revised: December 26, 2010
Accepted: January 2, 2011
Published online: August 7, 2011
Abstract

AIM: To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.

METHODS: Fifty-six patients (26 men, 30 women; mean age 42.8 ± 14.7 years) presenting for minimally invasive surgery for oesophageal achalasia, were enrolled. All patients underwent laparoscopic Heller myotomy followed by a 180° anterior partial fundoplication in 30 cases (group 1) and calibrated Nissen-Rossetti fundoplication in 26 (group 2). Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication. A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken. One and two years after surgery, the patients underwent symptom questionnaires, endoscopy, oesophageal manometry and 24 h oesophago-gastric pH monitoring.

RESULTS: At the 2-year follow-up, no significant difference in the median symptom score was observed between the 2 groups (P = 0.66; Mann-Whitney U-test). The median percentage time with oesophageal pH < 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group (2; range 0.8-10 vs 0.35; range 0-2) (P < 0.0001; Mann-Whitney U-test).

CONCLUSION: Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia. Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure.

Keywords: Achalasia, Dor fundoplication, Dysphagia, Gastroesophageal reflux, Laparoscopy, Nissen-Rossetti fundoplication