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Anterior Dor or Posterior Toupet with Heller Myotomy for Achalasia Cardia: A Systematic Review and Meta-Analysis

  • Manjunath Siddaiah-SubramanyaEmail author
  • Rossita Mohamad Yunus
  • Shahjahan Khan
  • Breda Memon
  • Muhammed Ashraf Memon
Scientific Review

Abstract

Background and Aims

Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures.

Material and Methods

A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed. The outcome variables analyzed included operating time, length of hospital stay (LOHS), overall complication rate, quality of life (QOL), postoperative reflux, residual postoperative dysphagia, treatment failure and reoperations. The meta-analysis was prepared in accordance with the PRISMA-P statement.

Results

Seven studies totaling 486 patients (Dor = 245, Toupet = 241) were analyzed. LOHS was significantly shorter for Toupet repair compared to Dor procedure (WMD 0.73, 95% CI 0.47 to 0.99; P < 0.0001). Furthermore, patients after Toupet experienced significantly better QOL than those after Dor (WMD 1.68, 95% CI 0.68 to 2.73, P < 0.001). All other variables showed comparable effects for these two procedures.

Conclusion

Our systematic review and meta-analysis revealed that Toupet fundoplication is superior to Dor in terms of LOHS and QOL following HM. For other variables such as postoperative reflux, postoperative dysphagia, complication rates and treatment failure, both Dor and Toupet fundoplication produced effective and equivalent results.

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that there is no conflict of interest.

Supplementary material

268_2019_4945_MOESM1_ESM.docx (329 kb)
Supplementary material 1 (DOCX 328 kb)

References

  1. 1.
    Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A et al (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364(19):1807–1816.  https://doi.org/10.1056/nejmoa1010502 CrossRefGoogle Scholar
  2. 2.
    Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A (2013) Laparoscopic Heller’s myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 78(3):468–475.  https://doi.org/10.1016/j.gie.2013.03.1335 CrossRefGoogle Scholar
  3. 3.
    Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M (2008) Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 248(6):1023–1030.  https://doi.org/10.1097/sla.0b013e318190a776 CrossRefGoogle Scholar
  4. 4.
    Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C et al (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26(1):18–26.  https://doi.org/10.1007/s00464-011-1822-y CrossRefGoogle Scholar
  5. 5.
    Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F et al (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249(1):45–57.  https://doi.org/10.1097/sla.0b013e31818e43ab CrossRefGoogle Scholar
  6. 6.
    Richardson WS, Kennedy CI, Bolton JS (2006) Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia. Surg Endosc 20(12):1914–1918.  https://doi.org/10.1007/s00464-006-0227-9 CrossRefGoogle Scholar
  7. 7.
    Falkenback D, Johansson J, Oberg S, Kjellin A, Wenner J, Zilling T et al (2003) Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus Off J Int Soc Dis Esophagus 16(4):284–290CrossRefGoogle Scholar
  8. 8.
    Hunter JG, Trus TL, Branum GD, Waring JP (1997) Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 225(6):655–664CrossRefGoogle Scholar
  9. 9.
    Oelschlager BK, Chang L, Pellegrini CA (2003) Improved outcome after extended gastric myotomy for achalasia. Arch Surg 138(5):490–495.  https://doi.org/10.1001/archsurg.138.5.490 CrossRefGoogle Scholar
  10. 10.
    Patti MG, Herbella FA (2010) Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type? J Gastrointest Surg 14(9):1453–1458.  https://doi.org/10.1007/s11605-010-1188-9 CrossRefGoogle Scholar
  11. 11.
    Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G et al (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248(6):986–993.  https://doi.org/10.1097/sla.0b013e3181907bdd CrossRefGoogle Scholar
  12. 12.
    Torres-Villalobos G, Coss-Adame E, Furuzawa-Carballeda J, Romero-Hernandez F, Blancas-Brena B, Torres-Landa S et al (2018) Dor versus Toupet fundoplication after laparoscopic Heller myotomy: long-term randomized controlled trial evaluated by high-resolution manometry. J Gastrointest Surg 22(1):13–22.  https://doi.org/10.1007/s11605-017-3578-8 CrossRefGoogle Scholar
  13. 13.
    Kumagai K, Kjellin A, Tsai JA, Thorell A, Granqvist S, Lundell L et al (2014) Toupet versus Dor as a procedure to prevent reflux after cardiomyotomy for achalasia: results of a randomised clinical trial. Int J Surg 12(7):673–680.  https://doi.org/10.1016/j.ijsu.2014.05.077 CrossRefGoogle Scholar
  14. 14.
    Kiudelis M, Kubiliute E, Sakalys E, Jonaitis L, Mickevicius A, Endzinas Z (2017) The choice of optimal antireflux procedure after laparoscopic cardiomyotomy: two decades of clinical experience in one center. Wideochir Inne Tech Maloinwazyjne 12(3):238–244.  https://doi.org/10.5114/wiitm.2017.68547 Google Scholar
  15. 15.
    Tomasko JM, Augustin T, Tran TT, Haluck RS, Rogers AM, Lyn-Sue JR(2014) Quality of life comparing dor and toupet after heller myotomy for achalasia. JSLS J Soc Laparoendosc Surg 18(3). Epub 2014/11/14.  https://doi.org/10.4293/jsls.2014.00191. PubMed PMID: 25392612; PubMed Central PMCID: PMCPMC4154402
  16. 16.
    Wright AS, Williams CW, Pellegrini CA, Oelschlager BK (2007) Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 21(5):713–718.  https://doi.org/10.1007/s00464-006-9165-9 CrossRefGoogle Scholar
  17. 17.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (2000) Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Rev Esp Salud Publica 74(2):107–118CrossRefGoogle Scholar
  18. 18.
    Hutton B, Catala-Lopez F, Moher D (2016) The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin (Barc) 147(6):262–266.  https://doi.org/10.1016/j.medcli.2016.02.025 CrossRefGoogle Scholar
  19. 19.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12CrossRefGoogle Scholar
  20. 20.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605.  https://doi.org/10.1007/s10654-010-9491-z CrossRefGoogle Scholar
  21. 21.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13.  https://doi.org/10.1186/1471-2288-5-13 CrossRefGoogle Scholar
  22. 22.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558.  https://doi.org/10.1002/sim.1186 CrossRefGoogle Scholar
  23. 23.
    Wg C (1954) The combination of estimates from different experiments. Biometric 10:101–129CrossRefGoogle Scholar
  24. 24.
    R. The R project for statistical computing 2018, July 02. Available from: https://www.r-project.org/
  25. 25.
    Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD et al (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26(2):296–311.  https://doi.org/10.1007/s00464-011-2017-2 CrossRefGoogle Scholar
  26. 26.
    Eckardt AJ, Eckardt VF (2011) Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol 8(6):311–319.  https://doi.org/10.1038/nrgastro.2011.68 CrossRefGoogle Scholar
  27. 27.
    Vantrappen G, Hellemans J (1980) Treatment of achalasia and related motor disorders. Gastroenterology 79(1):144–154Google Scholar
  28. 28.
    Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140(9):827–833.  https://doi.org/10.1001/archsurg.140.9.827 CrossRefGoogle Scholar
  29. 29.
    Junghard O, Wiklund I (2008) Validation of a four-graded scale for severity of heartburn in patients with symptoms of gastroesophageal reflux disease. Value Health J Int Soc Pharmacoeconomics Outcomes Res 11(4):765–770.  https://doi.org/10.1111/j.1524-4733.2007.00313.x CrossRefGoogle Scholar
  30. 30.
    Torres-Villalobos G, Martin-Del-Campo LA (2013) Surgical treatment for achalasia of the esophagus: laparoscopic heller myotomy. Gastroenterol Res Pract 2013:708327.  https://doi.org/10.1155/2013/708327 CrossRefGoogle Scholar
  31. 31.
    Clarke A (1996) Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change. Qual Health Care QHC 5(3):172–179CrossRefGoogle Scholar
  32. 32.
    Velanovich V, Karmy-Jones R (1998) Measuring gastroesophageal reflux disease: relationship between the health-related quality of life score and physiologic parameters. Am Surg 64(7):649–653Google Scholar
  33. 33.
    Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus Off J Int Soc Dis Esophagus 20(2):130–134.  https://doi.org/10.1111/j.1442-2050.2007.00658.x CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Manjunath Siddaiah-Subramanya
    • 1
    • 2
    Email author
  • Rossita Mohamad Yunus
    • 3
  • Shahjahan Khan
    • 4
  • Breda Memon
    • 5
  • Muhammed Ashraf Memon
    • 1
    • 4
    • 5
    • 6
    • 7
  1. 1.Mayne Medical School, School of MedicineUniversity of QueenslandBrisbaneAustralia
  2. 2.Department of General SurgerySir Charles Gairdner HospitalNedlands, PerthAustralia
  3. 3.Institute of Mathematical SciencesUniversity of MalayaKuala LumpurMalaysia
  4. 4.School of Agricultural, Computing and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences ResearchUniversity of Southern QueenslandToowoombaAustralia
  5. 5.South East Queensland Surgery (SEQS) and Sunnybank Obesity CentreSunnybankAustralia
  6. 6.Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
  7. 7.Faculty of Health and Social ScienceBolton UniversityBoltonUK

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