Laparoscopic Heller Cardiomyotomy with Dor Fundoplication versus Nissen Fundoplication in the Management of Type II Achalasia: A Prospective Randomized Study

Abstract

Background: Surgery is considered the treatment of choice for esophageal achalasia as it achieves better and longer-lasting symptomatic relief. Laparoscopic Heller cardiomyotomy is the standard procedure with partial or complete fundoplication as an anti-reflux measure. Aim of the work:To compare results between Dor and Nissen fundoplication after laparoscopic Heller cardiomyotomy in type II achalasia regarding postoperative GERD and dysphagia. Patients and methods:This prospective randomized study was conducted on (40) patients who presented to the outpatient clinics suffering from chronic dysphagia from May 2017 to May 2019 with minimal follow for 12 months. Group A (20) patients underwent laparoscopic Heller cardiomayotomy with Dor fundoplication and group B (20) patients underwent laparoscopic Heller cardiomayotomy with Nissen fundoplication.Results: Regarding dysphagia and gastroesophageal reflux no significant differences were noted postoperatively between Dor fundoplication and Nissen fundoplication with Heller cardio-myotomy. At the end of follow-up, dysphagia occurred in 10% and 20% of patients belonging to the Dor and Nissen groups respectively (p=0.517), while reflux occurred in 10 % of patients with Dor fundoplication, with no cases of reflux after the Nissen fundoplication (p=0.163). Conclusion:Dor and Nissen fundoplication after heller cardiomyotomy showed good control of postoperative reflux with non-significant dysphagia if done properly. The choice of associated anti-reflux procedure is up to the surgeon's preference and experience.