Minimally Invasive '3-Stitch' Modification of the Dor Fundoplication: Simple and Effective
| Autor: | Andrew F. Feczko, Usman Ahmad, Scott Gabbard, Prashanthi N. Thota, Siva Raja, Sudish C. Murthy, Saurav Adhikari, Monisha Sudarshan |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Myotomy Adult Male medicine.medical_specialty medicine.medical_treatment Achalasia Heller Myotomy medicine Humans Minimally Invasive Surgical Procedures In patient Longitudinal Studies Prospective Studies Heller myotomy business.industry Suture Techniques Reflux Middle Aged medicine.disease Esophageal dysmotility Surgery Esophageal Achalasia Treatment Outcome Esophagoplasty Cohort Female Cardiology and Cardiovascular Medicine business Esophagitis |
| Zdroj: | The Annals of thoracic surgery. 113(1) |
| ISSN: | 1552-6259 |
| Popis: | Background A 180-degree anterior (Dor) fundoplication is usually paired with an esophagogastric myotomy in the surgical treatment of achalasia. The traditional technique, however, is not easily reversible and the execution is variable. This study examined a simplified ‘‘3-stitch’’ Dor fundoplication that addressed these challenges and presented the results. Methods A prospectively collected, longitudinal surgical achalasia database was queried for patients undergoing a Heller myotomy with ‘3-stitch 180-degree fundoplication from 2008 to 2019. Preoperative and postoperative Eckardt score, postoperative DeMeester score (24- or 48-hour pH studies), and endoscopic evidence of esophagitis were collected and analyzed to determine the effectiveness and safety of the fundoplication. Length of stay and complications were also considered. Results The pH testing was performed in 296 patients, with 17% (50 of 296) demonstrating abnormal esophageal acid exposure. Of this group, only 8% (16 of 201) manifested clinical esophagitis on upper endoscopy. A total of 14% (7 of 50) of patients with abnormal esophageal acid exposure were symptomatic. Total postoperative Eckhardt scores for this cohort were 3 or lower in 92% of patients, with a dysphagia-specific score of 0 in 92%. The technical details of a modified 180-degree anterior fundoplication are described. Conclusions The 3-stitch Dor fundoplication is an effective addition to a minimally invasive Heller myotomy, with good palliation of symptoms and an acceptable rate of acid reflux. The simplified construction anticipates the potential progression of esophageal dysmotility in patients with achalasia, and the modified technique is reproducible and readily teachable. |
| Databáze: | OpenAIRE |
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