V.v. Grubnik, A.v. Malynovskyi, V.v. Ilyashenko. Odessa national medical university, Ukraine
INTRODUCTION: The type of anti-reflux procedure to be used as an adjunct to laparoscopic Heller cardiomyotomy (LHCM) for oesophgeal achalasia is controversial. We compared results of LHCM with and without Dor fundoplication in a randomized controlled trial.
METHODS AND PROCEDURES: From 2009 to 2014, 42 patients undergoing LHCM were randomized to receive Dor fundoplication (group I, 20 patients), or no anti-reflux procedure (group II, 22 patients). Primary outcome measures were: rates of recurrences and gastro-esophageal reflux. Secondary outcome measure was operative time. Symptomatic outcomes were evaluated using modified Mellow and Pinkas dysphagia scale, and GERD-HRQL questionnaire. Objective outcomes were evaluated by barium swallow study and 24h pH study. Time frame was 2 years.
RESULTS: There were no significant differences between groups in respect to age, gender, and preoperative dysphagia scores. All procedures were completed without mortality and serious complications. Mean operative time was higher in Dor group (130 vs 92 min, p < 0.05). Mean follow-up period was 25.4 months (range, 24 – 28 months). Complete relief of dysphagia, confirmed by barium swallow, was observed in 17 patients (85 %) from group I (i.e., with Dor fundoplication), and in 21 patients (95.5 %) from group II (i.e., without fundoplication), p > 0.05. There were no statistically significant differences in dysphagia score (0.8 vs 0,3,) and GERD-HRQL score (1.9 vs 2.4, p > 0.05). Mean DeMeester score was higher in group II, but also have not gained statistically significant difference (23.4 vs 42.1, p > 0.05).
CONCLUSION: Laparoscopic Heller cardiomyotomy can be performed without Dor fundoplication with similar results in relief of dysphagia and prevalence of gastro-esophageal reflux.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77335
Program Number: P393
Presentation Session: Poster (Non CME)
Presentation Type: Poster
