Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia.

Autor:	Suman S; Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND., Varshney VK; Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND., Soni S; Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND., Sachdeva S; Department of Gastroenterology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, IND., Hussain S; Department of Gastroenterology, Dr. Sampurnanand Medical College, Jodhpur, IND., Bhargava N; Department of Gastroenterology, Dr. Sampurnanand Medical College, Jodhpur, IND.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2022 Oct 13; Vol. 14 (10), pp. e30243. Date of Electronic Publication: 2022 Oct 13 (Print Publication: 2022).
DOI:	10.7759/cureus.30243
Abstrakt:	Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. Methodology This prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and high-resolution manometry (HRM) at the one-year follow-up. Results There was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). Conclusions The study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2022, Suman et al.)
Databáze:	MEDLINE
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