Faculty Collaboration Database

Limited Hiatal Dissection Without Fundoplication Results in Comparable Symptomatic Outcomes to Laparoscopic Heller Myotomy with Anterior Fundoplication. J Laparoendosc Adv Surg Tech A 2016 Jul;26(7):506-10

Date

02/27/2016

Pubmed ID

26919162

DOI

10.1089/lap.2015.0523

Scopus ID

2-s2.0-84978484247 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: Previous randomized controlled trials have demonstrated that partial fundoplication following Heller myotomy results in less pathologic acid exposure to the esophagus when compared to myotomy without fundoplication. Recent studies have questioned the necessity of a fundoplication, especially when a limited hiatal dissection (LHD) is performed and the angle of His is preserved.

MATERIALS AND METHODS: This is a retrospective review of prospectively maintained data. All patients underwent primary Heller myotomy for achalasia over a 30-month period. In select patients, an LHD was performed anteriorly. Symptomatic outcomes were assessed up to 2 years postoperation using the Achalasia Severity Questionnaire (ASQ), Gastrointestinal Quality of Life Index (GIQLI), and Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL).

RESULTS: A total of 31 patients underwent Heller myotomy during the study interval. The majority of patients underwent Heller myotomy with full hiatal dissection (FHD) (21, 68%). Intraoperative mucosal perforations occurred in 3 (14%) patients undergoing FHD. Patient demographics, surgery details, and baseline symptomatic outcomes did not differ significantly preoperatively. At greater than 1 year postoperation, there was no significant difference between the groups for ASQ, GERD-HRQL, and GIGLI (P = .76, .78, and .33, respectively).

CONCLUSIONS: Heller myotomy with LHD and no fundoplication and Heller myotomy with FHD and partial fundoplication result in similar GERD-related quality of life outcomes. Further studies (including pH studies) are necessary to determine if fundoplication is a necessary step in selected patients in whom an LHD is possible.

Author List

DeHaan RK, Frelich MJ, Gould JC

Author

Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Digestive System Surgical Procedures
Esophageal Achalasia
Female
Fundoplication
Humans
Male
Middle Aged
Postoperative Complications
Quality of Life
Retrospective Studies
Surveys and Questionnaires
Treatment Outcome