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

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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.

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Authors and Affiliations

  1. Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Manjunath Siddaiah-Subramanya & Muhammed Ashraf Memon

  2. Department of General Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA, 6009, Australia

    Manjunath Siddaiah-Subramanya

  3. Institute of Mathematical Sciences, University of Malaya, Kuala Lumpur, Malaysia

    Rossita Mohamad Yunus

  4. School of Agricultural, Computing and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, QLD, Australia

    Shahjahan Khan & Muhammed Ashraf Memon

  5. South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Suite 9, McCullough Centre, 259 McCullough Street, Sunnybank, QLD, Australia

    Breda Memon & Muhammed Ashraf Memon

  6. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia

    Muhammed Ashraf Memon

  7. Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK

    Muhammed Ashraf Memon

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  1. Manjunath Siddaiah-Subramanya
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Correspondence to Manjunath Siddaiah-Subramanya.

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Siddaiah-Subramanya, M., Yunus, R.M., Khan, S. et al. Anterior Dor or Posterior Toupet with Heller Myotomy for Achalasia Cardia: A Systematic Review and Meta-Analysis. World J Surg 43, 1563–1570 (2019). https://doi.org/10.1007/s00268-019-04945-9

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  • DOI: https://doi.org/10.1007/s00268-019-04945-9

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