Document Detail

Partial Anterior vs Partial Posterior Fundoplication Following Transabdominal Esophagocardiomyotomy for Achalasia of the Esophagus: Meta-regression of Objective Postoperative Gastroesophageal Reflux and Dysphagia.
MedLine Citation:
PMID:  23324843     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVES To review transabdominal esophagocardiomyotomy (surgical treatment of achalasia) of the esophagus and to compare outcomes of partial anterior vs partial posterior fundoplication. DATA SOURCES An electronic search was conducted among studies published between January 1976 and September 2011 using the keywords achalasia, myotomy, antireflux surgery, and fundoplication. STUDY SELECTION Prospective studies of transabdominal esophagocardiomyotomy were selected. DATA EXTRACTION Outcomes selected were recurrent or persistent postoperative dysphagia and an abnormal 24-hour pH test result. Studies were divided into the following 3 groups: myotomy only, myotomy with anterior fundoplication, and myotomy with posterior fundoplication. Studies were weighted by the number of patients and by the follow-up duration. Event rates were calculated using meta-regression of the log-odds with the inverse variance method. DATA SYNTHESIS Thirty-nine studies with a total of 2998 patients were identified. The odds of postoperative dysphagia were 0.06 (95% CI, 0.03-0.12) for myotomy only, 0.11 (95% CI, 0.09-0.14) for myotomy with anterior fundoplication, and 0.06 (95% CI, 0.04-0.08) for myotomy with posterior fundoplication. The odds of a postoperative abnormal 24-hour pH test result were 0.37 (95% CI, 0.12-1.08) for myotomy only, 0.16 (95% CI, 0.11-0.24) for myotomy with anterior fundoplication, and 0.18 (95% CI, 0.13-0.25) for myotomy with posterior fundoplication. The increased odds of postoperative dysphagia in the group undergoing myotomy with anterior fundoplication compared with the group undergoing myotomy with posterior fundoplication were statistically significant (P < .001). However, the incidence of a postoperative abnormal 24-hour pH test result was statistically similar. CONCLUSION Partial posterior fundoplication when combined with an esophagocardiomyotomy may be associated with significantly lower reintervention rates for postoperative dysphagia, while providing similar reflux control compared with partial anterior fundoplication.
Ashwin A Kurian; Neil Bhayani; Ahmed Sharata; Kevin Reavis; Christy M Dunst; Lee L Swanström
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JAMA surgery     Volume:  148     ISSN:  2168-6262     ISO Abbreviation:  JAMA Surg     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101589553     Medline TA:  JAMA Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  85-90     Citation Subset:  AIM; IM    
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