Related Experiment Video
Updated: May 23, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Does the addition of a fundoplication improve outcomes for patients undergoing laparoscopic Heller's cardiomyotomy?
Damian Mayo1, Ewen A Griffiths, Omar A Khan
1Department of Upper Gastrointestinal Surgery, Royal Hampshire County Hospital, Winchester, United Kingdom.
Insights
Adding a fundoplication to laparoscopic Heller's cardiomyotomy for achalasia reduces gastro-oesophageal reflux. Partial fundoplication may also lower dysphagia rates compared to Nissen fundoplication.
Area of Science:
- Gastrointestinal Surgery
- Surgical Outcomes
- Achalasia Treatment
Background:
- Laparoscopic Heller's cardiomyotomy is a standard achalasia treatment.
- The role of routine fundoplication alongside Heller's procedure is debated.
Purpose of the Study:
- To evaluate if adding fundoplication to laparoscopic Heller's cardiomyotomy improves clinical outcomes.
- To assess the impact on gastro-oesophageal reflux and dysphagia.
Main Methods:
- Systematic review of best evidence, including meta-analyses, randomized controlled trials, and prospective series.
- Analysis of 8 selected papers from an initial search of 207 relevant studies.
Main Results:
- Addition of anti-reflux procedures significantly reduces gastro-oesophageal reflux, confirmed by pH monitoring and symptom reporting.
- No significant clinical differences observed between Dor anterior and Toupet posterior fundoplications.
- Partial fundoplication appears to result in lower dysphagia rates than Nissen fundoplication.
Conclusions:
- Routine fundoplication in conjunction with laparoscopic Heller's cardiomyotomy effectively reduces gastro-oesophageal reflux.
- Partial fundoplication may offer an advantage over Nissen fundoplication regarding postoperative dysphagia.
Abstract:
Laparoscopic Heller's cardiomyotomy is a well-established technique in the treatment of achalasia. However, the addition of a routine fundoplication as part of this procedure remains controversial. A best evidence topic in upper gastrointestinal surgery was written according to a structured protocol. The question addressed whether the addition of a fundoplication improved clinical outcomes. Two hundred and seven papers were found using the reported search and of these, 8 papers were identified using a pre-determined criteria as representing the best answer to this clinical question. There were 2 meta-analyses, 3 randomised controlled trials and 3 prospective series. The author, journal, date and country of publication, patient group, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. Review of the data shows that the rates of gastro-oesophageal reflux both on pH monitoring and symptom reporting are all reduced when an anti-reflux procedure is added to a Heller's cardiomyotomy. In terms of the choice of the anti-reflux procedure, comparison between the Dor anterior and Toupet posterior fundoplications do not show any obvious clinical differences, however dysphagia appears to be lower in those undergoing partial fundoplication as compared to a Nissen fundoplication.
