| A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? | |
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MedLine Citation:
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PMID: 16308004 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Myotomy for achalasia disrupts the lower esophageal sphincter, improving emptying at the expense of reflux. We hypothesized that surgical palliation of achalasia requires balancing desirable improvement in esophageal emptying with undesirable production of gastroesophageal reflux. Therefore, we objectively studied the physiologic effects of adding Dor fundoplication to Heller myotomy. METHODS: From December 1996 to June 2004, 149 patients underwent Heller myotomy; 88 (59%) had additional Dor fundoplication. The adequacy of myotomy was assessed by premyotomy to postmyotomy change in lower esophageal sphincter pressures, esophageal emptying by change in timed barium esophagram, and gastroesophageal reflux by postoperative 24-hour pH monitoring. RESULTS: For adequacy of myotomy, postmyotomy resting lower esophageal sphincter pressure was higher with (median, 18 mm Hg) than without (median, 13 mm Hg) Dor fundoplication (P = .002), as was residual lower esophageal sphincter pressure (median, 4.6 vs 1.8 mm Hg; P = .01). For esophageal emptying, postmyotomy barium height and width were similar with or without Dor fundoplication (P > .1). For gastroesophageal reflux, percentage of upright time with a pH of less than 4 was lower with (median, 0.4%) than without (median, 2.9%) Dor fundoplication (P = .005), and percentage of supine time with a pH of less than 4 was lower with (median, 0%) than without (median, 5.8%) Dor fundoplication (P = .007). CONCLUSIONS: The addition of Dor fundoplication reduces the adequacy of myotomy without impairing emptying and reduces reflux. Heller myotomy and Dor fundoplication balance emptying and reflux and therefore should be the surgical treatment of choice for achalasia. |
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Authors:
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Thomas W Rice; Alicia A McKelvey; Joel E Richter; Mark E Baker; Michael F Vaezi; Jingyuan Feng; Sudish C Murthy; David P Mason; Eugene H Blackstone |
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Publication Detail:
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Type: Journal Article Date: 2005-10-26 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 130 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2005 Dec |
Date Detail:
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Created Date: 2005-11-25 Completed Date: 2006-03-21 Revised Date: 2006-07-18 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1593-600 Citation Subset: AIM; IM |
Affiliation:
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Center for Swallowing and Esophageal Disorders and the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. ricet@ccf.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Digestive System Surgical Procedures
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methods Esophageal Achalasia / complications, surgery* Esophageal Sphincter, Lower / surgery* Female Fundoplication / methods* Gastroesophageal Reflux / etiology, surgery Humans Male Middle Aged |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2006 Jul;132(1):216-7; author reply 217
[PMID:
16798361
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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