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

Document Type : Original Article

Authors

General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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.

Keywords

Ain Shams Journal of Surgery
Volume 15, Issue 1
January 2022
Pages 17-25

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