W S Richardson1, C I Kennedy, J S Bolton. 1. Department of Surgery, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
Abstract
BACKGROUND: This study aimed to compare the outcomes for Heller myotomy alone and combined with different partial fundoplications. METHODS: The authors retrospectively reviewed their experience with 69 laparoscopic myotomies and 14 Heller myotomies, 80% of which were performed with partial fundoplication including 20 Toupet, 18 Dor, and 17 modified Dor procedures, in which the fundoplication is sutured to both sides of the crura and not the myotomy. RESULTS: The mean age of the study patients was 69 years (range, 15-80 years). Four mucosal perforations were repaired intraoperatively. There was one small bowel fistula in an area of open hernia repair distant from the myotomy. One patient with severe chronic obstructive pulmonary disease died of pneumonia. Phone follow-up evaluation was achieved in 68% of the cases at a mean of 37 months (range, 2-97 months). The results for no dysphagia and for heartburn requiring proton pump inhibitors, respectively, were as follows: Heller myotomy (85.7%, 28.5%), Toupet (66.6%, 33.3%), Dor (83.3%, 20%), and modified Dor (84.6%, 15.3%). Two patients with reflux strictures required annual dilation (Toupet, Dor). Two patients required revisions: one redo Heller myotomy (Dor) and one esophageal replacement (Toupet). CONCLUSION: Heller myotomy provides excellent dysphagia relief with or without fundoplication. Heartburn is a significant problem for a minority of patients. In the authors' hands, Toupet had the worst results and modified Dor was most protective for heartburn.
BACKGROUND: This study aimed to compare the outcomes for Heller myotomy alone and combined with different partial fundoplications. METHODS: The authors retrospectively reviewed their experience with 69 laparoscopic myotomies and 14 Heller myotomies, 80% of which were performed with partial fundoplication including 20 Toupet, 18 Dor, and 17 modified Dor procedures, in which the fundoplication is sutured to both sides of the crura and not the myotomy. RESULTS: The mean age of the study patients was 69 years (range, 15-80 years). Four mucosal perforations were repaired intraoperatively. There was one small bowel fistula in an area of open hernia repair distant from the myotomy. One patient with severe chronic obstructive pulmonary disease died of pneumonia. Phone follow-up evaluation was achieved in 68% of the cases at a mean of 37 months (range, 2-97 months). The results for no dysphagia and for heartburn requiring proton pump inhibitors, respectively, were as follows: Heller myotomy (85.7%, 28.5%), Toupet (66.6%, 33.3%), Dor (83.3%, 20%), and modified Dor (84.6%, 15.3%). Two patients with reflux strictures required annual dilation (Toupet, Dor). Two patients required revisions: one redo Heller myotomy (Dor) and one esophageal replacement (Toupet). CONCLUSION: Heller myotomy provides excellent dysphagia relief with or without fundoplication. Heartburn is a significant problem for a minority of patients. In the authors' hands, Toupet had the worst results and modified Dor was most protective for heartburn.
Authors: Giovanni Zaninotto; Vito Annese; Mario Costantini; Alberto Del Genio; Michela Costantino; Magdalena Epifani; Giovanni Gatto; Vittorio D'onofrio; Luigi Benini; Sandro Contini; Daniela Molena; Giorgio Battaglia; Berardino Tardio; Angelo Andriulli; Ermanno Ancona Journal: Ann Surg Date: 2004-03 Impact factor: 12.969
Authors: William O Richards; Alfonso Torquati; Michael D Holzman; Leena Khaitan; Daniel Byrne; Rami Lutfi; Kenneth W Sharp Journal: Ann Surg Date: 2004-09 Impact factor: 12.969
Authors: Marco G Patti; Piero M Fisichella; Silvana Perretta; Carlos Galvani; Maria V Gorodner; Thomas Robinson; Lawrence W Way Journal: J Am Coll Surg Date: 2003-05 Impact factor: 6.113
Authors: Constantine T Frantzides; Ronald E Moore; Mark A Carlson; Atul K Madan; John G Zografakis; Ali Keshavarzian; Claire Smith Journal: J Gastrointest Surg Date: 2004-01 Impact factor: 3.452
Authors: D Falkenback; J Johansson; S Oberg; A Kjellin; J Wenner; T Zilling; F Johnsson; C S Von Holstein; B Walther Journal: Dis Esophagus Date: 2003 Impact factor: 3.429
Authors: Daniel T Dempsey; Matthew Delano; Kevin Bradley; Jeffrey Kolff; Carol Fisher; Dina Caroline; John Gaughan; John E Meilahn; John M Daly Journal: Ann Surg Date: 2004-06 Impact factor: 12.969