A Total Fundoplication Is Not an Obstacle to Esophageal Emptying After Heller Myotomy for Achalasia: Results of a Long-term Follow Up

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Objective:The aim of this study was to evaluate the role and efficacy of a total 360° 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° fundoplication is generally regarded as an obstacle to esophageal emptying.Matherials 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.

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