A total fundoplication is not an obstacle to esophageal emptying after heller myotomy for achalasia: results of a long-term follow up.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the role and efficacy of a total 360 degrees wrap, Nissen-Rossetti fundoplication, after esophagogastromyotomy in the treatment of esophageal achalasia.

SUMMARY BACKGROUND DATA:

Surgery actually achieves the best results in the treatment of esophageal achalasia; the options vary from a short extramucosal esophagomyotomy to an extended esophagogastromyotomy with an associated partial fundoplication to restore the main antireflux barrier. A total 360 degrees fundoplication is generally regarded as an obstacle to esophageal emptying.

MATERIALS AND METHODS:

Since 1992 to November 2003, a total of 195 patients (91 males, 104 females), mean age 45.2 years (range, 12-79 years), underwent laparoscopic treatment of esophageal achalasia. Intervention consisted of Heller myotomy and Nissen-Rossetti fundoplication with intraoperative endoscopy and manometry.

RESULTS:

In 3 patients (1.5%), a conversion to laparotomy was necessary. Mean operative time was 75 +/- 15 minutes. No mortality was observed. Overall major morbidity rate was 2.1%. Mean postoperative hospital stay was 3.6 +/- 1.1 days (range, 1-12 days). At a mean clinical follow up of 83.2 +/- 7 months (range, 3-141 months) on 182 patients (93.3%), an excellent or good outcome was observed in 167 patients (91.8%) (dysphagia DeMeester score 0-1). No improvement of dysphagia was observed in 4 patients (2.2%). Gastroesophageal pathologic reflux was absent in all the patients.

CONCLUSIONS:

Laparoscopic Nissen-Rossetti fundoplication after Heller myotomy is a safe and effective treatment of esophageal achalasia with excellent results in terms of dysphagia resolution, providing total protection from the onset of gastroesophageal reflux.

• Authors: Gianluca Rossetti, Luigi Brusciano, Giuseppe Amato, Vincenzo Maffettone, Vincenzo Napolitano, Gianluca Russo, Domenico Izzo, Federica Russo, Francesco Pizza, Gianmattia Del Genio, Alberto Del Genio
• Journal: Annals of surgery (Ann Surg) Vol. 241 Issue 4 Pg. 614-21 (Apr 2005) ISSN: 0003-4932 [Print] United States
• PMID: 15798463 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Child
• Cohort Studies
• Combined Modality Therapy
• Digestive System Surgical Procedures (adverse effects, methods)
• Esophageal Achalasia (diagnosis, surgery)
• Esophagoscopy (adverse effects, methods)
• Female
• Follow-Up Studies
• Fundoplication (adverse effects, methods)
• Humans
• Male
• Manometry
• Middle Aged
• Minimally Invasive Surgical Procedures
• Quality of Life
• Recovery of Function
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome