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Updated: Jun 21, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Symmetrical anterior-posterior partial fundoplication: technique and outcomes
Hideyuki Takeuchi1,2, Andrés R Latorre-Rodríguez1,3, Lorenzo Cusmai1,4
1Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W Thomas Road, Suite 500, Phoenix, AZ, 85013, USA.
Background:
Partial fundoplication is the most common surgical treatment for gastroesophageal reflux disease (GERD). Our preferred technique is a symmetrical anterior-posterior partial (300°) fundoplication created along the natural axis of the stomach, leaving the bare area on the esophagus along the lesser curvature. We assessed perioperative and long-term outcomes of this technique.
Methods:
We retrospectively reviewed records of all patients who underwent primary elective antireflux surgery by a single foregut surgeon from September 2016 to December 2024. Non-primary and emergency procedures and other techniques (such as Dor) were excluded. Perioperative complications, hiatal hernia recurrence, patient-reported outcomes (PROMs), and patient satisfaction were assessed for up to 7 years.
Results:
We identified 355 patients (254 [71.5%] women; median age, 64 years) who underwent primary antireflux surgery (laparoscopic [79.2%], robotic [20.6%], and conversion [0.3%]). The median operative time, estimated blood loss, and length of stay were 90 min (IQR 70-110), 25 mL (IQR 10-25), and 1 day (IQR 1-2). Severe complications (Clavien-Dindo grade ≥ III) occurred in 3 (0.8%) patients. There was no 90-day mortality. GERD health-related quality of life (GERD-HRQL) questionnaires and/or objective assessment using barium esophagram or upper GI endoscopy were completed by 222/355 (62.5%), 134/322 (41.6%), 56/267 (21.0%), 43/166 (25.9%), and 19/90 (21.1%) patients at 1, 2, 3, 5, and 7 years, respectively. The median total GERD-HRQL scores improved from 32 (IQR 13-46) preoperatively to 1 (IQR 0-4), 2 (IQR 0-7), 2 (IQR 0-12), 1 (IQR 0-6), and 5 (IQR 1-24) at 1, 2, 3, 5, and 7 years, respectively. Over 7 years, objective HH recurrence occurred in 22 patients (≥ 2 cm in 5 patients).
Conclusions:
Symmetrical anterior-posterior partial fundoplication is safe and effective, providing sustainable relief from GERD symptoms with high patient satisfaction reported up to 7 years. Interpretation of these promising results is limited by the small number of patients with extended follow-up.
