A Total Fundoplication Is Not an Obstacle to Esophageal Emptying After Heller Myotomy for Achalasia

Rossetti, Gianluca; Brusciano, Luigi; Amato, Giuseppe; Maffettone, V.; Napolitano, Vincenzo; Russo, Gianluca; Izzo, Domenico; Russo, Federica; Pizza, Francesco; Genio, Gianmattia del; Genio, A. Del

doi:10.1097/01.sla.0000157271.69192.96

Cited by 108 publications

(73 citation statements)

References 62 publications

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“…The fact is that those patients benefited from the operation, yet did not attain the ideal outcome 25 . On adopting this failure criterion based on a dysphagia questionnaire, the option favored an already published parameter with a higher clinical sensitivity 21,22,30,31 . However, this choice entailed having an increased number of cases classified as failures, which actually exhibited a partial improvement.…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

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Qualidade de vida após a cardiomiotomia à Heller-Dor

Madureira¹,

Madureira²,

Loss³

et al. 2009

Rev. Col. Bras. Cir.

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, were studied retrospectively. Before surgery, the demographics and the diagnostic test results were recorded. The patients submitted a dysphagia score for quality of life before and after surgery, and lower esophageal sphincter pressure (PLES) was measured. We also studied the difference produced in quality of life Results:Results: Results: Results: Results: 37 women and 23 men were followed. Mean age was 41.08 (12-87). There was no mortality and no conversions. The mean time of diet resumption was 1.6 day. The outcome was considered excellent in 80% of the series and intermediate in 20% of the series. The mean dysphagia score before surgery was 9.03 points, and after surgery, 1.7 point (maximum of 10 points), p=0.0001. The mean score decrease between pre-and postoperative scores was 7.33 points (87.17%). The mean PLES before surgery was 32.41 mmHg, and 12.7 mmHg after. Conclusion:Conclusion: Conclusion: Conclusion: Conclusion: HDL is a safe procedure and changed significantly the subjective quality of life scores, as well as the objective PLES means.

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Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…Few patients required reoperation in the available series; the great majority was treated by PCD or the botulinum toxin 21,22,[27][28][29][30][32][33][34] .…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Qualidade de vida após a cardiomiotomia à Heller-Dor

Madureira¹,

Madureira²,

Loss³

et al. 2009

Rev. Col. Bras. Cir.

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“…Rossetti and collaborators stress that a total Nissen fundoplication only when performed by an experienced surgeon, in a reference centre for functional esophageal surgery, has a very low risk of dysphagic complication and equivalent to that of Dor fundoplication [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…A first group of authors choose a 360° plication claiming to have a statistically insignificant recurrence rate of dysphagia, and almost no incidence of GERD [26][27][28][29]. Rossetti and collaborators stress that a total Nissen fundoplication only when performed by an experienced surgeon, in a reference centre for functional esophageal surgery, has a very low risk of dysphagic complication and equivalent to that of Dor fundoplication [28,29].…”

Section: Discussionmentioning

confidence: 99%

Fundoplication After Heller Myotomy: A Retrospective Comparison Between Nissen and Dor

Cuttitta

Tancredi²,

Andriulli

et al. 2011

EAJM

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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. Bulgular: Dor fundoplikasyon tedavisi Nissen fundoplikasyondan daha fazla disfaji ve yetersizlik şiddet skorunu önemli (p<0.0001) ölçüde azaltmıştır. Sonunda, "disfajik" olarak değerlendirmenin DeMeester skorunun 3 (keyfi cut-off ) alındığı bir hastada, gerçekten de, Dor fundoplikasyon ile tedavi edilenlere göre floppy-Nissen ile tedavi edilen hastalarda disfaji insidansı oranı anlamlı derecede daha yük-sek bulunmuştur. Sırasıyla H+N ve H+D grubu grubundaki hastalarda %17.65 ve %0 (p=0.037) takip hastalığı (disfaji) oluşmuştur. Sonuç:Heller miyotomi-Dor fundoplikasyon güvenli ve değerli bir tedavi yöntemidir. Bu prosedür, postoperatif disfajiye karşı Nissen fundoplikasyon daha düşük bir insidans ve ihmal edilebilir bir oranda ameliyat sonrası uzun süreli bir takip de ameliyat sonrası GÖRH göstermiştir.

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“…The most frequent postoperative complications are the recurrence of dysphagia and gastroesophageal reflux; the former is due to an incomplete myotomy, a fundoplication that is too tight, or a tight scar stricture, whereas the latter is due to an inefficient antireflux fundoplication [1,[15][16][17][18][19][20][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

et al. 2017

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Objective: The aim of the present study is to show the predictive value of the preoperative resting pressure of the lower esophageal sphincter (LES) correlated with the type of fundoplication (Nissen or Dor) after Heller myotomy in our series. Materials and Methods:From January 1998 to June 2010, 88 patients affected by esophageal achalasia underwent surgery at our unit. However, our study focused on a sample of 36 patients, because many data were lost or was never recorded. Among these, 14 patients underwent laparoscopic Heller myotomy plus Nissen fundoplication (group N), whereas 22 patients underwent laparoscopic Heller myotomy plus Dor fundoplication (group D). Clinical evaluation was performed using a modified DeMeester symptom scoring system consisting of the assessment of three symptoms: dysphagia, regurgitation, and heartburn. To each symptom was assigned a score from 0 to 3, depending on its severity, and the reduction in the severity of each symptom after surgery was assessed.Results: The surgical treatment is considered to be effective (p<0.0001). The preoperative resting pressures of LES were compared by Student's t-test, and it was found that patients who reported a greater improvement in the dysphagia symptom had a preoperative average pressure of LES that was significantly higher than that in other patients in both group N (p=0.03) and group D (p=0.01; p=0.003; p=0.001). The Dor treatment was shown to be more effective than the Nissen treatment (p<0.0001). Conclusion:The preoperative resting pressure of LES is a predictive factor of surgical success both before Dor fundoplication and before Nissen fundoplication, but its predictive power is influenced by the chosen type of fundoplication.Keywords: Achalasia, dysphagia, preoperative resting pressure of LES, predictive factors, fundoplication ÖZ Amaç: Bu çalışmanın amacı, serimizdeki Heller miyotomi sonrasında, funduplikasyon türü (Nissen veya Dor) ile ilişkili olarak alt özofageal sfinkterin (AÖS) preoperatif istirahat basıncının prediktif değerini göstermektir.Gereç ve Yöntem: Ocak 1998 ile Haziran 2010 arasında, özofageal akalazyadan etkilenen 88 hasta birimimizde ameliyat oldular. Ancak çalışmamızda, birçok verinin kaybolmasından veya hiç kaydedilmemiş olmasından dolayı, 36 hastaneden oluşan bir örnekleme odaklanıldı. Bu hastalardan 14'üne laparoskopik Heller miyotomi+Nissen fundoplikasyon (N grubu) uygulanırken, 22'sine laparoskopik Heller miyotomi+Dor fundoplikasyon (D grubu) uygulandı. Klinik değerlendirme, disfaji, regürjitasyon ve mide yanması olan üç semptomun değerlendirilmesini içeren modifiye DeMeester semptom skorlama sistemi kullanılarak yapıldı. Her bir semptoma 0 ile 3 arası bir puan verildi ve ameliyat sonrası her semptomun şiddetindeki azalma değerlendirildi.Bulgular: Cerrahi tedavinin etkili olduğu düşünülmektedir (p<0,0001). Ameliyat öncesi AÖS istirahat basınçları Student's t-test ile karşılaştırıldı. Disfaji semptomunda gelişme görülen hastalarda ameliyat öncesi ortalama AÖS basıncı, N grubu (p=0,03) ve D grubundaki (p...

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A Total Fundoplication Is Not an Obstacle to Esophageal Emptying After Heller Myotomy for Achalasia

Abstract: Laparoscopic Nissen-Rossetti fundoplication after Heller myotomy is a safe and effective treatment of esophageal achalasia with excellent results in terms of dysphagia resolution, providing total protection from the onset of gastroesophageal reflux.

Cited by 108 publications

References 62 publications

Qualidade de vida após a cardiomiotomia à Heller-Dor

Qualidade de vida após a cardiomiotomia à Heller-Dor

Fundoplication After Heller Myotomy: A Retrospective Comparison Between Nissen and Dor

Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

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