Dor Vs Toupet Fundoplication After Laparoscopic Heller Myotomy: Long-Term Randomized Controlled Trial Evaluated by High-Resolution Manometry
| Autor: | Angélica Rodríguez-Garcés, Axel A. Hernández-Ávila, Gonzalo Torres-Villalobos, Samuel Torres-Landa, Edgar Alejandro-Medrano, Cecilia Ramírez Angulo, Athenea Flores-Najera, Axel Palacios-Ramírez, Lourdes Margarita Ávila Escobedo, Blanca Blancas-Breña, Fernanda Romero-Hernández, Janette Furuzawa-Carballeda, Miguel A. Valdovinos, Enrique Coss-Adame |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Esophageal pH Monitoring Time Factors Adolescent Manometry Achalasia Fundoplication Heller Myotomy Esophageal Sphincter Lower law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Randomized controlled trial law Pressure Medicine Humans Laparoscopy High resolution manometry Aged Heller myotomy medicine.diagnostic_test business.industry Gastroenterology Hydrogen-Ion Concentration Middle Aged medicine.disease Surgery Esophageal Achalasia Treatment Outcome 030220 oncology & carcinogenesis Esophageal sphincter 030211 gastroenterology & hepatology Female Esophagoscopy Symptom Assessment business Esophageal pH monitoring Laparoscopic Heller Myotomy |
| Zdroj: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 22(1) |
| ISSN: | 1873-4626 |
| Popis: | Laparoscopic Heller myotomy (LHM) with partial fundoplication is an effective treatment for achalasia. However, the type of fundoplication is still a subject of debate. The aim of the study is to identify which partial fundoplication leads to better control of acid exposure, manometric parameters, and symptoms scores. A randomized controlled trial was performed to compare Dor vs Toupet fundoplication after LHM. The preoperative diagnosis was made by high-resolution manometry (HRM), upper endoscopy, and barium esophagogram. Preoperative and postoperative symptoms were evaluated with Eckardt, GERD-HRQL, and EAT-10 questionnaires. Seventy-three patients were randomized, 38 underwent Dor and 35 Toupet. Baseline characteristics were similar between groups. Postoperative HRM showed that the integrated relaxation pressure (IRP) and basal lower esophageal sphincter (LES) pressure were similar at 6 and 24 months. The number of patients with abnormal acid exposure was significantly lower for Dor (6.9%) than that of Toupet (34.0%) at 6 months, but it was not different at 12 or 24 months. No differences were found in postoperative symptom scores at 1, 6, or 24 months. There were no differences in symptom scores or HRM between fundoplications in the long term. A higher percentage of abnormal 24-h pH test were found for the Toupet group, with no difference in the long term. |
| Databáze: | OpenAIRE |
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