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Selective application of fundoplication during laparoscopic heller myotomy ensures favorable outcomes
Mark Bloomston1, Alexander S Rosemurgy
1Division of General Surgery, Department of Surgery, University of South Florida, Tampa 33601, USA.
Abstract:
We propose that selective fundoplication during laparoscopic Heller myotomy achieves optimal outcomes. Fundoplication was applied selectively in 21 of 100 patients undergoing laparoscopic Heller myotomy with hiatus hernia, patulous esophageal hiatus, or intraoperative perforation. Dysphagia and heartburn incidence and severity in patients undergoing myotomy with or without fundoplication were compared before and after myotomy. Median follow-up was 19 months and was similar for both groups. Preoperative symptoms were similar for both groups of patients and showed significant improvement following myotomy with or without fundoplication. As well, there were no significant differences in postoperative dysphagia (26% vs. 14%), dysphagia score (1.1 +/- 1.4 vs. 0.8 +/- 1.3), heartburn (21% vs. 27%), or heartburn score (0.9 +/- 1.5 vs. 1.4 +/- 1.6). Overall improvement was seen in 86% of patients undergoing myotomy with fundoplication and in 97% without fundoplication (P = 0.06). Selective application of fundoplication during laparoscopic Heller myotomy promotes optimal outcomes.
Insights
Selective fundoplication during laparoscopic Heller myotomy offers optimal outcomes for achalasia patients. This approach demonstrated comparable results to standard myotomy, with no significant differences in dysphagia or heartburn post-surgery.
Area of Science:
- Gastroenterology and Surgical Innovation
- Minimally Invasive Esophageal Surgery
Background:
- Laparoscopic Heller myotomy is a standard treatment for achalasia.
- The role of concomitant fundoplication in Heller myotomy remains debated, particularly regarding its impact on postoperative symptoms.
Purpose of the Study:
- To evaluate the outcomes of selective fundoplication during laparoscopic Heller myotomy.
- To compare symptom recurrence, specifically dysphagia and heartburn, in patients who underwent myotomy with or without fundoplication.
Main Methods:
- A retrospective analysis of 100 patients undergoing laparoscopic Heller myotomy.
- Fundoplication was selectively applied in 21 patients with specific indications (hiatus hernia, patulous hiatus, perforation).
- Preoperative and postoperative dysphagia and heartburn severity were compared between groups with a median follow-up of 19 months.
Main Results:
- Both myotomy with and without fundoplication groups showed significant preoperative symptom improvement.
- No significant differences were observed in postoperative dysphagia (26% vs. 14%) or heartburn (21% vs. 27%) rates.
- Overall improvement was high in both groups (86% with fundoplication vs. 97% without), with no statistically significant difference (P = 0.06).
Conclusions:
- Selective application of fundoplication during laparoscopic Heller myotomy is a safe and effective approach.
- This strategy achieves optimal patient outcomes without compromising symptom relief compared to myotomy alone.