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Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial.

Publication ,  Journal Article
Richards, WO; Torquati, A; Holzman, MD; Khaitan, L; Byrne, D; Lutfi, R; Sharp, KW
Published in: Ann Surg
September 2004

OBJECTIVE: We sought to determine the impact of the addition of Dor fundoplication on the incidence of postoperative gastroesophageal reflux (GER) after Heller myotomy. SUMMARY BACKGROUND DATA: Based only on case series, many surgeons believe that an antireflux procedure should be added to the Heller myotomy. However, no prospective randomized data support this approach. PATIENTS AND METHODS: In this prospective, randomized, double-blind, institutional review board-approved clinical trial, patients with achalasia were assigned to undergo Heller myotomy or Heller myotomy plus Dor fundoplication. Patients were studied via 24-hour pH study and manometry at 6 months postoperatively. Pathologic GER was defined as distal esophageal time acid exposure time greater than 4.2% per 24-hour period. The outcome variables were analyzed on an intention-to-treat basis. RESULTS: Forty-three patients were enrolled. There were no differences in the baseline characteristics between study groups. Pathologic GER occurred in 10 of 21 patients (47.6%) after Heller and in 2 of 22 patients (9.1%) after Heller plus Dor (P = 0.005). Heller plus Dor was associated with a significant reduction in the risk of GER (relative risk 0.11; 95% confidence interval 0.02-0.59; P = 0.01). Median distal esophageal acid exposure time was lower in the Heller plus Dor (0.4%; range, 0-16.7) compared with the Heller group (4.9%; range, 0.1-43.6; P = 0.001). No significant difference in surgical outcome between the 2 techniques with respect to postoperative lower-esophageal sphincter pressure or postoperative dysphagia score was observed. CONCLUSIONS: Heller Myotomy plus Dor Fundoplication was superior to Heller myotomy alone in regard to the incidence of postoperative GER.

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Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

September 2004

Volume

240

Issue

3

Start / End Page

405 / 412

Location

United States

Related Subject Headings

  • Surgery
  • Postoperative Complications
  • Middle Aged
  • Manometry
  • Male
  • Laparoscopy
  • Hydrogen-Ion Concentration
  • Humans
  • Gastroesophageal Reflux
  • Fundoplication
 

Citation

APA
Chicago
ICMJE
MLA
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Richards, W. O., Torquati, A., Holzman, M. D., Khaitan, L., Byrne, D., Lutfi, R., & Sharp, K. W. (2004). Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 240(3), 405–412. https://doi.org/10.1097/01.sla.0000136940.32255.51
Richards, William O., Alfonso Torquati, Michael D. Holzman, Leena Khaitan, Daniel Byrne, Rami Lutfi, and Kenneth W. Sharp. “Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial.Ann Surg 240, no. 3 (September 2004): 405–12. https://doi.org/10.1097/01.sla.0000136940.32255.51.
Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004 Sep;240(3):405–12.
Richards, William O., et al. “Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial.Ann Surg, vol. 240, no. 3, Sept. 2004, pp. 405–12. Pubmed, doi:10.1097/01.sla.0000136940.32255.51.
Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004 Sep;240(3):405–412.

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

September 2004

Volume

240

Issue

3

Start / End Page

405 / 412

Location

United States

Related Subject Headings

  • Surgery
  • Postoperative Complications
  • Middle Aged
  • Manometry
  • Male
  • Laparoscopy
  • Hydrogen-Ion Concentration
  • Humans
  • Gastroesophageal Reflux
  • Fundoplication