Related Experiment Video
Updated: Oct 14, 2025
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Heller myotomy versus Heller myotomy with fundoplication in patients with achalasia: a systematic review and
G Santoro1, N Sheriff1, J Noronha2
1Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK.
Insights
Heller myotomy (HM) with fundoplication (HMF) shows no significant difference in achalasia outcomes compared to HM alone. This meta-analysis found similar rates of gastroesophageal reflux and dysphagia between the two surgical approaches.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Digestive System Diseases
Background:
- Heller myotomy (HM) is the standard surgical treatment for achalasia.
- The addition of fundoplication to HM (HMF) is debated due to conflicting study results.
- This meta-analysis aims to clarify outcomes of HM versus HMF.
Purpose of the Study:
- To compare the long-term outcomes of Heller myotomy (HM) versus HM with fundoplication (HMF) for achalasia.
- To evaluate differences in gastroesophageal reflux and dysphagia rates between HM and HMF.
Main Methods:
- Systematic electronic search of five databases (PubMed, Ovid, Scopus, Cochrane Library, Google Scholar) up to October 2019.
- Inclusion of randomized and non-randomized studies comparing HM and HMF.
- Random-effects meta-analysis of primary (gastroesophageal reflux) and secondary (dysphagia) outcomes.
Main Results:
- Six studies involving 576 patients were analyzed.
- No statistically significant difference in gastroesophageal reflux between HM and HMF groups (21.3% vs. 22.9%, p=0.49).
- A trend towards higher dysphagia incidence in the HM group compared to HMF (14.8% vs. 10.8%, p=0.06).
Conclusions:
- Heller myotomy with fundoplication does not offer statistically significant long-term outcome advantages over Heller myotomy alone for achalasia.
- Both procedures demonstrate comparable efficacy in managing achalasia symptoms.
- Further research may be warranted to explore subtle differences in specific patient subgroups.
Introduction:
Heller myotomy (HM) remains the gold standard procedure for achalasia. The addition of different types of fundoplication to HM has been debated in several studies. Given the contradictory reports, this meta-analysis was undertaken to compare different outcomes after HM and HM with fundoplication (HMF).
Methods:
An electronic search was performed among five major databases (PubMed, Ovid, Scopus, Cochrane Library, Google Scholar) from inception to October 2019, identifying all randomised and non-randomised studies comparing HM with HMF. Two authors searched electronic databases using the keywords 'achalasia' AND 'dysphagia' AND 'gastroesophageal reflux' and all data were pooled for random-effects meta-analysis. The primary and secondary outcomes were gastroesophageal reflux and dysphagia, respectively.
Results:
A total of six studies were included and involved 576 patients comparing HM and HMF. There was no statistically significant difference between gastroesophageal reflux in the HM vs HMF group (21.3% vs 22.9%, RR 1.32, 95% CI 0.60-2.88, p = 0.49). There was a slightly higher incidence of dysphagia observed in HM vs HMF (14.8% vs 10.8%, RR 1.54, 95% CI 0.98-2.41, p = 0.06).
Conclusions:
There was no statistically significant difference in long-term outcomes between a group of patients undergoing HM and a group who underwent HM with fundoplication.
Related Concept Videos
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...